Jackson Collision & Classics Employment Application

Employment Application
Name
Date
Position Applying For
Address
City, State, Zip
Cell Phone
Home Phone
Do you have a valid driver's license?

YesNo
Do you have adequate transportation to and from work?

YesNo
Have you been cited for a traffic violation of any kind within the last 5 years?

YesNo
If yes, please give date and details:
Who were you referred by?

Education
High School Name
Grades Completed:

9th10th11th12th
Did you receive your diploma?

YesNo
College/University Name
Course of Study / Major:
Degree Obtained:
Describe Specialized Training, Military Experience, Skills & Extracurricular Activities

Employment

Please list the names of your previous employers in chronological order with present or last employer listed first. Be sure to account for all periods of time including military service and any period of unemployment. If you were self-employed, give the business name and supply business references.
Present or Last Employer
Address, City, State, Zip
Phone Number
Dates Employed To-From
Your Title or Position
Starting Salary
Final Salary
Name of Last Supervisor
Reason For Leaving

Previous Employer 2
Address, City, State, Zip
Phone Number
Dates Employed To-From
Your Title or Position
Starting Salary
Final Salary
Your Last Supervisor
Reason For Leaving

Previous Employer 3
Address, City, State, Zip
Phone Number
Dates Employed To-From
Your Title or Position
Starting Salary
Final Salary
Your Last Supervisor
Reason For Leaving

Previous Employer 4
Address, City, State, Zip
Phone Number
Dates Employed To-From
Your Title or Position
Starting Salary
Final Salary
Your Last Supervisor
Reason For Leaving

Previous Employer 5
Address, City, State, Zip
Phone Number
Dates Employed To-From
Your Title or Position
Starting Salary
Final Salary
Reason For Leaving
Your Last Supervisor

References

List professional references who are familiar with the quality of your work, have worked directly with you, and have known you for at least two years.
Reference 1 Name
Occupation
Address
Phone Number
Years Known
Reference 2 Name
Occupation
Address
Phone Number
Years Known
Reference 3 Name
Occupation
Address
Phone Number
Years Known
Reference 4 Name
Occupation
Address
Phone Number
Years Known

Additional Information
Have you ever been terminated or asked to resign from any job?

YesNo
If yes, explain the circumstances:
Please explain any gaps in your employment history:
May we contact your most current employer?

YesNo
Have you ever pled guilty or "no contest" to, or been convicted of a misdemeanor or felony?

YesNo
If yes, give details and dates of each:
Have you been arrested for any matter for which you are out on bail or on your own recognizance pending trial?

YesNo

Remarks and Special Qualifications / Training / Certifications - Please also include any computer systems / software / programs with which you are familiar.
By clicking 'Submit', you hereby state that all the information you provided on this application is true and correct.
Signature

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