Driven Brands - Job Form

NAME
First Name*
Last Name*
Social Security Number*

PRESENT ADDRESS
Country*
Street 1*
Street 2
City*
State*
Zip*
Lived Here Since*

PAST ADDRESS
Country
Street 1
Street 2
City
State
Zip
Lived Here From

CONTACT
Day / Cell Phone*
Home Phone
Email*

EMPLOYMENT DESIRED*
	Full-Time Part-Time Hours per week
Position
Start Date
Expected Salary
	Are you currently employed?
	Yes No
	If so, may we inquire of your present employer?
	Yes No

CRIMINAL RECORD*	Have you ever been convicted of any misdemeanor or felony (except minor traffic violation)?
	Yes No
	If yes, give the date and nature of the conviction:

	A “Yes” answer does not automatically disqualify you from employment, since the nature of the offense, date, and the job for which you are applying will also be considered.

PERFORMANCE*	Are you able to perform the essential duties of this position?
	Yes No

PAST EMPLOYMENT*
Start Date
End Date
Position
Company Name
Company Address
City
State
Supervisor’s Name
Phone
May we contact?	Yes No
Beginning Salary
End Salary
Reason for Leaving

Start Date
End Date
Position
Company Name
Company Address
City
State
Supervisor’s Name
Phone
May we contact?	Yes No
Beginning Salary
End Salary
Reason for Leaving

Start Date
End Date
Position
Company Name
Company Address
City
State
Supervisor’s Name
Phone
May we contact?	Yes No
Beginning Salary
End Salary
Reason for Leaving

EDUCATION*
High School
City
State
Grade Completed
Did you graduate?	Yes No

College or University
City
State
Grade Completed
Did you graduate?	Yes No
Major Subject

Trade, Business, Etc.
City
State
Grade Completed
Did you graduate?	Yes No
Major Subject

	Have you ever been fired from a job?
	Yes No
	If yes, please explain:


	In addition to your employment history and education, what other experiences, skills or qualifications do you have that would benefit our company?

CLERICAL*	Adding Machine
	Computer Software
	Excel
	Word
	Access
	Outlook
	PowerPoint
	Publisher
	Other
	Switchboarding
	Layout Editing
	Filing
	Typing, Speed, WPM

TECHNICAL*	Pipe Bender
	Pattern Bend
	Sight Bend
	Card Bend
	Cutting
	Welding
	Torch
	Swedge
	Personal Tools
	Tool Box
	Alignment
	Radiator/Transmission Flush
	Brake Lathe on Car
	Brake Lathe off Car
	CV Joints
	Ball Joints
	ASE Certification
	Smog License #
	NIASE Certification
	Brake License #
	Additional Training and Skills:


	Additional Machine / Equipment Experience:

ACKNOWLEDGEMENT

I hereby affirm, on penalty of non-hire or dismissal, that all of my answers and statements made herein and other information given by me pursuant to seeking employment with the company are true, complete and accurate, and made in good faith. I understand that as part of the procedure in processing this application there may be a background investigation and reference check, and I consent and authorize the company to conduct this investigation and release the company from any liability in making said inquiries or relying on information received. If at any time it is determined that the information provided by me herein is incorrect, incomplete or untrue, I accept and acknowledge that as sufficient grounds for immediate dismissal.

I authorize all individuals contacted, including my former employers, to furnish the company with the information sought concerning my services, my reason for leaving employment, and any other information they may have relating to me. I hereby release any individuals from any liability in furnishing said information.

I understand that the company may request as a condition of employment that I undergo a drug screening test. I further understand that, if hired, the company may request me to undergo drug screening tests from time to time. I agree to any such testing as required now or in the future. I agree to execute all consent forms requested for said testing and understand that a satisfactory result of any drug screening test is a necessary condition of any offer of employment or continued employment.

I understand that if I am employed by the company, I must abide by the rules and policies of the company and acknowledge that these rules and policies may be changed, interpreted, withdrawn or added to by the company at the company’s discretion, without any prior notice.

I understand that if I am employed, my employment is for no definite or stated period and may be terminated at any time for any legal reason without any previous notice.

I further acknowledge that no company representative has made promises to the contrary guaranteeing me employment for any specified period of time, and that no employment handbook or policy may be construed to the contrary or interpreted as a contract or guarantee of employment.

In compliance with the immigration reform and control act of 1986, I understand that if offered employment, I will be required to provide approved documentation that verifies my right to work in the united states on my first day of employment.

I certify and declare under penalty of perjury under relevant state and federal law that the information contained in my employment application is complete, true, and accurate. I acknowledge that falsification or omission of information may result in immediate dismissal or retraction of any offer of employment. I authorize all persons and organizations that may have information relevant to this research to disclose such information to EMPLOYER or its authorized agents. I hereby release EMPLOYER, its authorized agents, and all persons and organizations providing information from all claims and liabilities of any nature in connection with this research.