Employment Application

POSITION APPLIED FOR*

REFERRAL SOURCE*

RELATIONSHIP TO REFERRAL SOURCE*

LAST NAME*

FIRST NAME*

MIDDLE NAME

SS#*

STREET*

CITY*

STATE*

ZIP CODE*

TELEPHONE #*

EMAIL ADDRESS/OTHER PHONE

HOW LONG HAVE YOU LIVED AT THE ABOVE ADDRESS?*

DO YOU HAVE A VALID DRIVERS LICENSE?*

Yes No

WHAT IS THE BEST NUMBER TO REACH YOU ON?*

WHEN IS THE BEST TIME TO CONTACT YOU?*

HAVE YOU SUBMITTED AN APPLICATION HERE BEFORE?*

Yes No

IF YES, GIVE DATE(S) AND POSITION(S)?

HAVE YOU EVER BEEN EMPLOYED HERE BEFORE?*

Yes No

IF YES, GIVE DATE(S) AND POSITION(S)

ARE YOU LEGALLY ELIGIBLE FOR EMPLOYMENT IN THIS COUNTRY?*

Yes No

DATE AVAILABLE FOR WORK*

DESIRED SALARY RANGE*

TYPE OF EMPLOYMENT DESIRED*

ARE YOU ABLE TO MEET THE ATTENDANCE REQUIREMENTS OF THE POSITION?*

Yes No

WILL YOU WORK OVERTIME IF REQUIRED?*

Yes No

IF NO, PLEASE EXPLAIN

HAVE YOU EVER PLED "GUILTY" OR "NO CONTEST" TO, OR BEEN CONVICTED, OF A CRIME?*

Yes No

IF YES, PLEASE PROVIDE A DATE(S) AND DETAILS

Answering 'Yes' to these questions does not constitute an automatic bar to employment. All factors will be taken into account.

DRIVER'S LICENSE*

STATE ISSUED*

Please provide information for your past & current employers, assignment or volunteer activities, starting with the most recent. Explain any gaps in employment in the comment section below.

Click the 'add a job' button to list off previous employment.

Add a job

Skills, qualifications and additional information: summarize any special training, skills, licenses and/or certificates that may qualify you as being able to perform job-related duties for which you are applying. List any professional trade, business or civid associations and offices held. Exclude memberships that would reveal race, colour, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any other similarly protected status.

Please add any educational facilities that you have been enrolled through by clicking the 'Add a school button', along with associated details. Only the most recent three are required, preferably starting with the most recent.

Failure to do so will mean that you will be listed as not having previous education of note.

Add a school

List the name and telephone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references whom are not related to you.

Reference 1

NAME*

RELATIONSHIP*

TELEPHONE*

# OF YEARS KNOWN*

Reference 2

NAME*

RELATIONSHIP*

TELEPHONE*

# OF YEARS KNOWN*

Reference 3

NAME*

RELATIONSHIP*

TELEPHONE*

# OF YEARS KNOWN*

APPLICANT STATEMENT:

I CERTIFY THAT ALL INFORMATION I HAVE PROVIDED IN ORDER TO APPLY FOR AND SECURE WORK WITH PERFORMANCE TIRE & WHEEL, INC. IS COMPLETE AND TRUE.

I UNDERSTAND THAT ANY INFORMATION PROVIDED BY ME THAT IS FOUND TO BE FALSE, INCOMPLETE OR MISREPRESENTED IN ANY RESPECT, WILL BE SUFFICIENT CAUSE TO (1)CANCEL FURTHER CONSIDERATION FOR THIS APPLICATION, OR (2)IMMEDIATELY DISCHARGE ME FROM THE EMPLOYER’S SERVICE, WHENEVER IT IS DISCOVERED.

I EXPRESSLY AUTHORIZE, WITHOUT RESERVATION, THE EMPLOYER, ITS REPRESENTATIVES, EMPLOYEES OR AGENTS TO CONTACT AND OBTAIN INFORMATION FROM ALL REFERENCES (PERSONAL AND PROFESSIONAL), EMPLOYERS, PUBLIC AGENCIES, LICENSING AUTHORITIES AND EDUCATIONAL INSTITUTIONS AND TO OTHERWISE VERIFY THE ACCURACY OF ALL INFORMATION PROVIDED BY ME IN THIS APPLICATION, RESUME OR JOB INTERVIEW. I HEREBY WAIVE ANY AND ALL RIGHTS AND CLAIMS I MAY HAVE REGARDING THE EMPLOYER, IT’S AGENTS, EMPLOYEES OR REPRESENTATIVES, FOR SEEKING, GATHERING AND USING SUCH INFORMATION IN THE EMPLOYMENT PROCESS AND ALL OTHER PERSONS, CORPORATION OR ORGANIZATIONS FOR FURNISHING SUCH INFORMATION ABOUT ME.

I UNDERSTAND THAT THE EMPLOYER DOES NOT UNLAWFULLY DISCRIMINATE IN EMPLOYMENT AND NO QUESTION ON THIS APPLICATION IS USED FOR THE PURPOSE OF LIMITING OR EXCUSING ANY APPLICANT FROM CONSIDERATION FOR EMPLOYMENT ON A BASIS PROHIBITED BY APPLICABLE LOCAL, STATE OR FEDERAL LAW.

I UNDERSTAND THAT THIS APPLICATION REMAINS CURRENT FOR ONLY 30 DAYS. AT THE CONCLUSION OF THAT TIME, IF I HAVE NOT HEARD FROM THE EMPLOYER AND STILL WISH TO BE CONSIDERED FOR EMPLOYMENT, IT WILL BE NECESSARY TO REAPPLY AND FILL OUT A NEW APPLICATION.

IF I AM HIRED, I UNDERSTAND THAT I AM FREE TO RESIGN AT ANY TIME, WITH OR WITHOUT CAUSE AND WITHOUT PRIOR NOTICE, AND THE EMPLOYER RESERVES THE SAME RIGHT TO TERMINATE MY EMPLOYMENT AT ANY TIME, WITH OR WITHOUT CAUSE AND WITHOUT PRIOR NOTICE, EXCEPT AS MAY BE REQUIRED BY LAW. THIS APPLICATION DOES NOT CONSTITUTE AN AGREEMENT OR CONTRACT FOR EMPLOYMENT FOR ANY SPECIFIED PERIOD OR DEFINITE DURATION. I UNDERSTAND THAT NO SUPERVISOR OR REPRESENTATIVE OF THE EMPLOYER IS AUTHORIZED TO MAKE ANY ASSURANCES TO THE CONTRARY AND THAT NO IMPLIED ORAL OR WRITTEN AGREEMENTS CONTRARY TO THE FOREGOING EXPRESS LANGUAGE ARE VALID UNLESS THEY ARE IN WRITING AND SIGNED BY THE EMPLOYER’S PRESIDENT.

I ALSO UNDERSTAND THAT IF I AM HIRED, I WILL BE REQUIRED TO PROVIDE PROOF OF IDENTITY AND LEGAL AUTHORITY TO WORK IN THE UNITED STATES AND THAT FEDERAL IMMIGRATION LAWS REQUIRE ME TO COMPLETE AN I-9 FORM IN THIS REGARD.

Employment Application

Reference 1

Reference 2

Reference 3

APPLICANT STATEMENT:

DO NOT SUBMIT UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.
I CERTIFY THAT I HAVE READ, FULLY UNDERSTAND AND ACCEPT ALL TERMS OF THE FOREGOING APPLICANT STATEMENT.

Thank you!

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Employment Application

Reference 1

Reference 2

Reference 3

APPLICANT STATEMENT:

DO NOT SUBMIT UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT. I CERTIFY THAT I HAVE READ, FULLY UNDERSTAND AND ACCEPT ALL TERMS OF THE FOREGOING APPLICANT STATEMENT.

Thank you!

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DO NOT SUBMIT UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.
I CERTIFY THAT I HAVE READ, FULLY UNDERSTAND AND ACCEPT ALL TERMS OF THE FOREGOING APPLICANT STATEMENT.