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 If you are human, leave this field blank. Submit
