Roadside Collision Employment Ap

Roadside Collision Employment Application
Download this application, then bring completed application to Roadside Collision office of your choice. General Instructions: 1. PRINT or write all information so that it is legible - DO NOT TYPE 2. If an item does not apply to you, or you have no information to furnish, print in the letters "N/A" meaning Not Applicable. 3. A completed application is required. Resumes may be submitted in addition to the application. 4. This application requires the applicant's signature and date of signature (refer to the last page of this application).
Position for which you are applying: Date:
Last Name:	First:		Middle:
Address:	Marital Status:		# of dependents:
City:	State:		Zip:
Date Available for work:		Minimum Salary Requirement
Social Security Number		DOB:
ANSWER THE FOLLOWING BY PLACING AN "X" IN THE APPROPRIATE COLUMN AND SUPPLY DETAILED EXPLANATIONS IN THE AREA BELOW AS NECESSARY. USE SUPPLEMENTAL SHEET IF NEEDED.

YES	NO		YES	NO
		1. Do you work well with others?			7. If you are in High School, do you have a valid Work Permit?
		2. Do you have reliable transportation to work?			8. If hired, will you engage in any other employment? If yes, please explain in the space provided below.
		3. Do you consent to the following: Drug Test, Polygraph Examination, Physical Examination, Psychological Examination, and Background Investigation?			9. Have you ever worked for Roadside Collision before? If yes, please list positions held and approximate dates of employment in the space provided below.
		4. Have you ever agreed to or been required to take a drug and/or alcohol test which resulted in a positive test within the past three years?			10. Have you ever been convicted of any law violation? (Include any plea of "guilty" or "no contest." Exclude minor traffic violations.) If yes, give details below. Convictions do not necessarily preclude you from employment.
		5. *If you are under the age of 18, can you provide an age verification form? If you are over the age of 18, write "N/A" for "Not Applicable*			11. If hired, can you furnish proof that you are eligible to work in the United States? If no, please explain in the space provided below.
		6. Are you able to perform the essential functions of the position for which you have applied with or without reasonable accommodation?			12. Is there anything else that we need to be aware of if we hire you? Explain below

EMPLOYMENT HISTORY: List all present and past employment. Applicants must provide 7 consecutive years of employment history. Please use supplemental sheet if more space is needed. If submitting résumé, please also include all information requested on this application.
Present or Last Employer:	Dates of Employment From ___ To ______ Mo/Yr. Mo./Yr.		Salary or Earnings Start: $ Per Final or Current: $ Per
Employer’s Address (Street, City and State)		Job Title:
Type of Business		Description of duties:
Name of Supervisor
May we contact? Yes □ No □
Phone ( )		Reason for Leaving or Wanting to Leave

Present or Last Employer:	Dates of Employment From ___ To ______ Mo/Yr. Mo./Yr.		Salary or Earnings Start: $ Per Final or Current: $ Per
Employer’s Address (Street, City and State)		Job Title:
Type of Business		Description of duties:
Name of Supervisor
May we contact? Yes □ No □
Phone ( )		Reason for Leaving or Wanting to Leave

Present or Last Employer:	Dates of Employment From ___ To ______ Mo/Yr. Mo./Yr.		Salary or Earnings Start: $ Per Final or Current: $ Per
Employer’s Address (Street, City and State)		Job Title:
Type of Business		Description of duties:
Name of Supervisor
May we contact? Yes □ No □
Phone ( )		Reason for Leaving or Wanting to Leave

Present or Last Employer:	Dates of Employment From ___ To ______ Mo/Yr. Mo./Yr.		Salary or Earnings Start: $ Per Final or Current: $ Per
Employer’s Address (Street, City and State)		Job Title:
Type of Business		Description of duties:
Name of Supervisor
May we contact? Yes □ No □
Phone ( )		Reason for Leaving or Wanting to Leave

Present or Last Employer:	Dates of Employment From ___ To ______ Mo/Yr. Mo./Yr.		Salary or Earnings Start: $ Per Final or Current: $ Per
Employer’s Address (Street, City and State)		Job Title:
Type of Business		Description of duties:
Name of Supervisor
May we contact? Yes □ No □
Phone ( )		Reason for Leaving or Wanting to Leave


OTHER EXPERIENCE		List any significant voluntary, military or other relevant experience that you feel further qualifies you for the position for which you are applying. Do not list organizations which would identify race, color, creed, sexual orientation, religion, age, sex, national origin or disability.
High School diploma or GED: Yes □ No □ Higher Education: Circle highest grade completed 13 14 15 16 17 18 Undergraduate Graduate Diploma/Degree obtained/Major Field of Study:
Names/Address (College, University or Business/Vocational School) Official transcripts may be required	Did you Graduate?		Degree/Major





Do you hold a valid driver’s license? Yes □ No □ State Licensed in __________________ Driver’s License Number Class Have you had your driver’s license suspended or revoked in the last three years? Yes □ No □ If yes, give details: Have you held a driver’s license in another state besides Alabama in the past 5 years? If so, what states? __________________________________

PROFESSIONAL REFERENCES

(Do not include friends or relatives)

NAME	ADDRESS	TELEPHONE	LENGTH AND TYPE OF ACQUAINTANCE

EQUAL OPPORTUNITY EMPLOYER

Roadside Collision is an Equal Opportunity Employer. All applicants are considered for all positions for which they apply and

qualify, regardless of race, color, creed, religion, sex, sexual orientation, age, national origin, or disability.

PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING

I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may justify my dismissal if discovered at a later date.

I authorize the investigation of any or all statements contained in this application and also authorize any person, school, current employer (except as previously noted), past employers and organizations named in this application to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.

I understand that if I am extended an offer of employment it may be conditioned upon my successfully completing any required training/examinations, and that, as required by the Immigration Act of 1986, I can provide identification which verifies my United States Citizenship or authorization to work or remain in the United States. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying. I understand that if I am extended an offer of employment, it will be conditional upon my agreement to Roadside Collision policies.

I have read, understand, and by my signature, consent to these and all statements contained within this application.

Signature: Date:

Have you held a driver’s license in another state besides Alabama in the past 5 years?

If so, what states? ­­­­__________________________________

If so, what states? __________________________________