VR-Application-for-Employment APPLICATION FOR EMPLOYMENT In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status. Answer all questions. Please, print. If the answer to any questions is “No” or “None”, do not leave the item blank, but write “No” or “None”. Position Applying for Type Full-time Part-time Date of Application Applicant Full Name Applicant Full Name Current Address Street Street City City State State Zip Code Zip Code How long? yr./mo. Previous Address Street Street City City State State Zip Code Zip Code How long? yr./mo. Date Available to start Are you 18 years of age or older? Yes No Social Security No. E-mail Address Cell Phone No. Cell Service Carrier Emergency Phone No. Emergency Contact Driver’s License # Class State Issued Expires A. Have you ever been denied a license, permit, or privilege to operate a motor vehicle? Yes No B. Has any license, permit, or privilege ever been suspended or revoked? Yes No IF THE ANSWER TO EITHER A OR B IS YES, GIVE DETAILS Are you a citizen of the United States? Yes No If no, are you authorized to work in the U.S.? Yes No Have you ever worked for this company before? Yes No If yes, when? Reason for leaving Are you employed now? Yes No If not, when was your last day employed? How did you hear about Vermillion Repair Shop / Olson Carriers? EMPLOYMENT HISTORY Please, list your work experience for the past TEN years beginning with your most recent job held.If you were self-employed, give firm name. Attach additional sheets if necessary. EMPLOYER NAME ADDRESS CITY STATE ZIP SUPERVISOR PHONE NUMBER POSITION HELD SALARY/WAGE REASON FOR LEAVING DATE FROM MO. MO. YR. YR. DATE TO MO. MO. YR. YR. LIST THE JOBS YOU HELD, DUTIES PERFORMED, SKILLS USED OR LEARNED, ADVANCEMENTS OR PROMOTIONS WHILE YOU WORKED AT THIS COMPANY MAY WE CONTACT YOUR PREVIOUS EMPLOYER FOR A REFERENCE? Yes No EMPLOYER NAME ADDRESS CITY STATE ZIP SUPERVISOR PHONE NUMBER POSITION HELD SALARY/WAGE REASON FOR LEAVING DATE FROM MO. MO. YR. YR. DATE TO MO. MO. YR. YR. LIST THE JOBS YOU HELD, DUTIES PERFORMED, SKILLS USED OR LEARNED, ADVANCEMENTS OR PROMOTIONS WHILE YOU WORKED AT THIS COMPANY MAY WE CONTACT YOUR PREVIOUS EMPLOYER FOR A REFERENCE? Yes No EMPLOYER NAME ADDRESS CITY STATE ZIP SUPERVISOR PHONE NUMBER POSITION HELD SALARY/WAGE REASON FOR LEAVING DATE FROM MO. MO. YR. YR. DATE TO MO. MO. YR. YR. LIST THE JOBS YOU HELD, DUTIES PERFORMED, SKILLS USED OR LEARNED, ADVANCEMENTS OR PROMOTIONS WHILE YOU WORKED AT THIS COMPANY MAY WE CONTACT YOUR PREVIOUS EMPLOYER FOR A REFERENCE? Yes No EMPLOYER NAME ADDRESS CITY STATE ZIP SUPERVISOR PHONE NUMBER POSITION HELD SALARY/WAGE REASON FOR LEAVING DATE FROM MO. MO. YR. YR. DATE TO MO. MO. YR. YR. LIST THE JOBS YOU HELD, DUTIES PERFORMED, SKILLS USED OR LEARNED, ADVANCEMENTS OR PROMOTIONS WHILE YOU WORKED AT THIS COMPANY MAY WE CONTACT YOUR PREVIOUS EMPLOYER FOR A REFERENCE? Yes No EMPLOYER NAME ADDRESS CITY STATE ZIP SUPERVISOR PHONE NUMBER POSITION HELD SALARY/WAGE REASON FOR LEAVING DATE FROM MO. MO. YR. YR. DATE TO MO. MO. YR. YR. LIST THE JOBS YOU HELD, DUTIES PERFORMED, SKILLS USED OR LEARNED, ADVANCEMENTS OR PROMOTIONS WHILE YOU WORKED AT THIS COMPANY MAY WE CONTACT YOUR PREVIOUS EMPLOYER FOR A REFERENCE? Yes No EDUCATION CIRCLE HIGHEST GRADE COMPLETED 1 2 3 4 5 6 7 8 9 10 11 12 COLLEGE 1 2 3 4 LAST SCHOOL ATTENDED (NAME)(CITY, STATE) EXPERIENCE AND QUALIFICATIONS – PLATFORM LIST TYPES OF PLATFORM EXPERIENCE AND YEARS OF EACH LIST PLATFORM EQUIPMENT YOU CAN OPERATE (LIFT-FORK ETC.) SHOW COURSES OR TRAINING IN PLATFORM WORK EXPERIENCE AND QUALIFICATIONS – MAINTENANCE LIST TYPES OF MAINTENANCE EXPERIENCE AND YEARS OF EACH SHOW EQUIPMENT YOU CAN OPERATE YEARS OF EXPERIENCE SHOW EQUIPMENT YOU CAN OPERATE YEARS OF EXPERIENCE SHOW EQUIPMENT YOU CAN OPERATE Woodworking Equipment YEARS OF EXPERIENCE SHOW EQUIPMENT YOU CAN OPERATE Electric Welder YEARS OF EXPERIENCE SHOW EQUIPMENT YOU CAN OPERATE Sheet Metal Equipment YEARS OF EXPERIENCE SHOW EQUIPMENT YOU CAN OPERATE Oxyacetylene Welder YEARS OF EXPERIENCE SHOW EQUIPMENT YOU CAN OPERATE Clutch Rebuilding YEARS OF EXPERIENCE SHOW EQUIPMENT YOU CAN OPERATE Paint Spray Gun YEARS OF EXPERIENCE SHOW EQUIPMENT YOU CAN OPERATE Differential Rebuilding YEARS OF EXPERIENCE SHOW EQUIPMENT YOU CAN OPERATE Wheel & Tire Balancing Machine YEARS OF EXPERIENCE SHOW EQUIPMENT YOU CAN OPERATE Transmission Rebuilding YEARS OF EXPERIENCE SHOW EQUIPMENT YOU CAN OPERATE Tire Recapping Mold YEARS OF EXPERIENCE SHOW EQUIPMENT YOU CAN OPERATE Body Work YEARS OF EXPERIENCE SHOW EQUIPMENT YOU CAN OPERATE Engine Dynamometer YEARS OF EXPERIENCE SHOW EQUIPMENT YOU CAN OPERATE Frame & Axle Straightening Equipment YEARS OF EXPERIENCE SHOW EQUIPMENT YOU CAN OPERATE Chassis Dynamometer YEARS OF EXPERIENCE SHOW EQUIPMENT YOU CAN OPERATE Electrical & Ignition Repair YEARS OF EXPERIENCE SHOW EQUIPMENT YOU CAN OPERATE Magnetic Crack Tester YEARS OF EXPERIENCE SHOW EQUIPMENT YOU CAN OPERATE Engine Rebuilding Equipment YEARS OF EXPERIENCE SHOW EQUIPMENT YOU CAN OPERATE Vacuum & Air Brakes YEARS OF EXPERIENCE SHOW EQUIPMENT YOU CAN OPERATE Diesel Injection Equipment YEARS OF EXPERIENCE Other: YEARS OF EXPERIENCE LIST COURSES AND TRAINING IN MAINTENANCE WORK EXPERIENCE AND QUALIFICATIONS – OTHER SHOW ANY WORK EXPERIENCE THAT MAY HELP IN YOUR WORK FOR THIS COMPANY LIST COURSES AND TRAINING OTHER THAN SHOWN ELSEWHERE IN THIS APPLICATION LIST SPECIAL EQUIPMENT OR TECHNICAL MATERIALS YOU CAN WORK WITH (OTHER THAN THOSE ALREADY SHOWN) MILITARY SERVICE BRANCH FROM TO RANK AT DISCHARGE TYPE OF DISCHARGE IF OTHER THAN HONORABLE, EXPLAIN TO BE READ AND SIGNED BY APPLICANT It is agreed and understood that any misrepresentation given above shall be considered an act of dishonesty. It is agreed and understood that Vermillion Repair Shop, LLC (hereinafter called “the Company”) or its agents may investigate the applicant's background to ascertain any and all information of concern to applicant's record, whether same is of record or not, and applicant releases employers and persons named herein from all liability for any damages on account of his/her furnishing such information. It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I understand that this investigation may include an Investigating Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living. I agree to furnish such additional information and complete such examinations as may be required to complete my employment file. It is agreed and understood that this application for qualification in no way obligates the Company to employ the applicant. It is agreed and understood that if qualified, the employee may be on a probationary period during which time he may be disqualified without recourse. It is agreed and understood that, if hired, my employment with the Company is on an At-Will basis. Employment is not a contract and the employer and/or employee can discontinue the employment relationship at any time. This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release Signature: signature keyboard Clear Date: Captcha Submit
