Personal Information
Which Schram Auto Parts location are you applying for?
Last Name:
First Name:
Middle Name:
Street Address:
City:
State:
Zip Code:
Telephone Number:
Mobile Phone Number:
E-Mail Address:
Position(s) applied for:
Date of Application:
23 May 2013
If you are under 18, and it is required, can you furnish a work permit?
If no, please explain:
Have you ever been employed here before?
If yes, give dates and position/s:
Are you legally eligible for employment in this country?
Type of employment desired:
Date Available for work:
What is your desired salary range:
Can you perform the essential duties of the job in which you wish to be employed,
with or without reasonable accommodation?
Are you able to meet the attendance requirements of the position?
Have you ever pled "guilty" or "no contest" to, or been convicted of a crime?
If yes, please provide date(s) and details.
Answering "YES" to these questions does not constitute and automatic bar to employment.
Factors such as date of the offense, seriousness of the violation,rehabilitation
and position applied for will be taken into account.
Driver's license number if driving is an essential job function:
State:
Employment History
List last employer first, including US military service.
First Previous Job:
From:
Employer:
Telephone #:
To:
Starting Job Title:
Street Address:
City:
State:
Final Job Title:
Zip Code:
Immediate Supervisor:
Title:
May we contact for reference?
Summarize the nature of the work performed and job responsibilities:
Reason for leaving:
Hourly rate / Salary:
Start:
Final:
Second Previous Job:
From:
Employer:
Telephone #:
To:
Starting Job Title:
Street Address:
City:
State:
Final Job Title:
Zip Code:
Immediate Supervisor:
Title:
May we contact for reference?
Summarize the nature of the work performed and job responsibilities:
Reason for leaving:
Hourly rate / Salary:
Start:
Final:
Third Previous Job:
From:
Employer:
Telephone #:
To:
Starting Job Title:
Street Address:
City:
State:
Final Job Title:
Zip Code:
Immediate Supervisor:
Title:
May we contact for reference?
Summarize the nature of the work performed and job responsibilities:
Reason for leaving:
Hourly rate / Salary:
Start:
Final:
Skills and Qualifications:
Summarize any training, skills, licenses, and / or certificates that may qualify
tou as being able to perform job-related functions in the position for which you
are applying:
Educational Background:
References:
Applicant Statement:
I certify that all information I
have provided in order to apply for and secure work with the employer is true, complete,
and correct.
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 (i) cancel further consideration of this application,
or (ii) 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 have regarding the employer, its agents, employees or representatives,
for seeking, gathering and using such
information in the employment process and all other persons, corporations or organizations
for furnishing such information about me.
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 an "at will" employee where as I am free to resign at any time, with or without
causes and without prior notice and the employer resaves the same right to terminate
my employment at any time, with or without cause and without prior notice, unless
otherwise 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 assurance
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 federal immigration laws require me to complete an I-9 Form in
this regard.
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.