Barney Brothers Application

Barney Brothers Off Road and Repair
APPLICATION FOR EMPLOYMENT

Red Asterisks are Required Fields
Equal Opportunity Employer

In order to provide equal employment and advancement opportunities to all individuals, employment decisions at Barney Brothers, Inc. will be based on merit, qualifications, and abilities. Barney Brothers, Inc. does not discriminate in employment opportunities or practices on the basis of race, color, religion, sex, national origin, age, disability, or any other characteristic protected by law. Barney Brothers, Inc. will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship. This policy governs all aspects of employment, including selection, job assignment, compensation, discipline, termination, and access to benefits and training. Any employee with questions or concerns about any type of discrimination in the workplace are encouraged to bring these issues to the attention of their immediate supervisor or the Human Resources Manager. Employees can raise concerns and make reports without fear of reprisal. Anyone found to be engaging in any type of unlawful discrimination will be subject to disciplinary action, up to and including termination of employment.
GENERAL INFORMATION
Full Name *

First Name Last Name
E-mail *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

Area Code Phone Number
Last 4 of SSN *
If applying for a Technician or Service writer position, do you have a valid Colorado drivers license? *

Yes No
If hired, can you furnish proof you are eligible to work in the U.S.? *

Yes No
Are you at least 18 years of age or older? *

Yes No
Are you at least 21 years of age or older? *

Yes No

Employment History Information
Work History: Current and previous 2 employers (most current employer listed first)
Company Name
City, State
Position Held
Start Date

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Date Finished

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Employer phone

Area Code Phone Number
Supervisor name

First Name Last Name
Describe your duties:
Reason for leaving
NEXT EMPLOYER
Company Name
City, State
Position Held
Start Date

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Date Finished

Month Day Year Date Picker Icon
Employer phone

Area Code Phone Number
Supervisor name

First Name Last Name
Describe your duties:
Reason for leaving
NEXT EMPLOYER
Company Name
City, State
Position Held
Start date

Month Day Year Date Picker Icon
Date Finished

Month Day Year Date Picker Icon
Employer phone

Area Code Phone Number
Supervisor name

First Name Last Name
Describe your duties:
Reason for leaving

Additional Information
Have you ever been convicted of a felony? *

Yes No
If yes, please give date and explain
Have you ever plead guilty, no contest, or been convicted of a crime? *

Yes No
If yes, please give date and explain
Have you ever been employed under a name other than the name used on this application? *

Yes No
If yes, please explain

I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial and other related matters as may be necessary for an employment decision. I hereby release employers, schools or individuals from all liability when responding to inquiries in connection with my application.

Certain consumer reports may be obtained as part of the evaluation of this job application/employment. The reports may be procured by American Family Insurance, (or another insurance provider) and may include your driving record, an assessment of your insurability under the company's insurance cpverages or other consumer reports.

By submitting this form you hereby authorize the company to procure such reports and additional reports from time to time as it deems appropriate, to evaluate your insurability and for other permissible purposes.

In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.

I understand and agree that, if hired my employment is "at will" and is not for a definate period and may, regardless of circumstances, be terminated at any time without prior notice by the Company. I further acknowledge that no contract of employment will be valid against the company.

If hired I acknowledge that I will read and abide by the Company Handbook & Policies & Procedures.

I acknowledge that as a condition of my employment, I will be required to agree to be bound by the terms of and sign this application. Failure to sign this Agreement shall result in revocation of my offer of employment.
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