Employment Application

Basic Information

• Last Name

  *
• First Name

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• Middle Name

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• Maiden Name

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• Address

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• City

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• State

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• Zip Code

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• How long have you been at this address?
• Phone

  *
• Email

  *

• Are you under the age of 18?

  Are you under the age of 18 ?

  Yes No

  *

• Can you provide proof of your eligibility to work?

  Proof of eligibility?

  Yes No

• Are you currently authorized to work in the United States?

  Are you currently authorized to work in the United States?

  Yes No

  *

  Proof of eligibility will be required if hired

• Which Department are you applying to? General Sales Parts Service Admin Office

  *
  What Position Are you applying for

  *
  What is your desired wage?

  *

• Days / Hours Available to Work:

  Hours desired

  No Pref Mon Tues Wed Thurs Fri Sat Sun

  *
  How many hours can you work weekly?

  Employment desired

  Full-Time Part-Time Full-or Part-Time
• When are you available to start?

  *

• Do you have any schedule conflicts within the next 12 months?

  Do you have any schedule conflicts within the next 12 months?

  Yes No

  *
• What are the conflicts?

High School

• Name of High School
• Location of High School
• Number of Years Completed
• Major or Degree

College

• Name of College
• Location of College
• Number of Years Completed
• Major or Degree

Other

• Name of School
• Location of School
• Number of Years Completed
• Major or Degree

Other

• Name of School
• Location of School
• Number of Years Completed
• Major or Degree

• Have you ever been convicted of a crime? (A Conviction record will not necessarily disqualify you from employment)

  Have you ever been convicted of a crime?

  Yes No

  *

• Explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) if rehabilitation.

  Explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) if rehabilitation.

• Do you have a Driver's License

  Do you have a Driver's License

  Yes No

  *
• What is your means of transportation to work?
• Driver's License
• State of Issue

• What type of license do you have?

  What type of license do you have?

  Operator Commercial(CDL) Chauffeur

• Have you had any accidents during the past three years?

  Have you had any accidents during the past three years?

  Yes No

  *
• How Many?

• Have you had any moving violations during the past three years?

  Have you had any moving violations during the past three years?

  Yes No

  *
• How Many?

• Basic Skills

• Can you type?

  Can you type?

  Yes No
• Avg. WPM

• Are you familiar with Excel?

  Are you familiar with Excel?

  Yes No

• Are you familiar with Word?

  Are you familiar with Word?

  Yes No

• Do you own a personal computer?

  Do you own a personal computer?

  Yes No
• Pc or Mac

  PC Mac
• Other Skills

• Please list two references other than relatives.

• Reference Name

  *
  Reference  Position

  *
  Reference  Company
  Reference  Address
  Reference  Phone Number

  *
• Reference Name

  *
  Reference  Position

  *
  Reference  Company
  Reference  Address
  Reference  Phone Number

  *
• Please use this space to elaborate on any background, experience, or qualifications that you believe should be considered in evaluating your qualifications for employment.  You may include hobbies, volunteer experience, and other activities you believe relevant.  Please omit any information that would disclose your race, gender, age, marital status, ethnic origin, religious or political affiliations, or disability.

  *

• Military Information

• Have you ever served in the armed forces?

  Have you ever served in the armed forces?

  Yes No

  *

• Are you now a member of the national guard?

  Are you now a member of the national guard?

  Yes No
• Specialty
• Date Entered
• Discharge Date

• Previous Employment History

• Empoyer Name

  *
• Name of Last Supervisor

  *
• Previous Job Title

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• Employer Address

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• Employer City

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• Employer State

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• Employer Zip

  *
• Reason for Leaving

  *
• Start Date

  *
  End Date

  *
• Start wage

  *
  End Wage

  *
• Please list all the duties performed, any promotions, and additional skills learned

  *

• Empoyer Name
• Name of Last Supervisor
• Previous Job Title
• Employer Address
• Employer City
• Employer State
• Employer Zip
• Reason for Leaving
• Start Date
  End Date
• Start wage
  End Wage
• Please list all the duties performed, any promotions, and additional skills learned

• Empoyer Name
• Name of Last Supervisor
• Previous Job Title
• Employer Address
• Employer City
• Employer State
• Employer Zip
• Reason for Leaving
• Start Date
  End Date
• Start wage
  End Wage
• Please list all the duties performed, any promotions, and additional skills learned

• Empoyer Name
• Name of Last Supervisor
• Previous Job Title
• Employer Address
• Employer City
• Employer State
• Employer Zip
• Reason for Leaving
• Start Date
  End Date
• Start wage
  End Wage
• Please list all the duties performed, any promotions, and additional skills learned

• May we contact your present employer?

  May we contact your present employer?

  Yes No

  *

• Did you complete this application yourself?

  Did you complete this application yourself?

  Yes No

  *

• Who did complete this for you?

  Who did complete this for you?

• Application form wavier

  As indication that you have read and understood each sentence, please write your initails in the space provided below.

  In exchange for the consideration of my job application to Middletown Tractor Sales, (hereinafter called "the Company"), I agree that:

  Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment or to confer any right to remain an employee of Middletown Tractor Sales, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the Owner/Managing Member of the Company, Both the undersigned and Middletown Tractor Sales may end the employment relationship at any time, without specified notice or reason. if employed I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

  I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, all previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contact.

  I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.

  I further understand that my employment with the Company shall be probationary for a period of ninety (90) days, and further that at any time during the probationary period or thereafter, my employment relationship with the Company is terminable at will for any reason by either party.

• Is there any additional information you would like to provide to us in considering your Application?
• Signature

  *
• Inital

  *
• Today's date

  *

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  Upload a Cover Letter

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