Diamonds Auto Glass Application for Employment

Applicant Information

Full Name:
Date:
 
Last
First
M.I.
Address:
Phone:
Email:
Date Available::
Social Security No.:
Desired Salary:
Position Applied for:

 

I am looking for the following kind of work:

Regular

Temporary

Either

I want to work:

Full-Time

Part-Time

Either

I am willing to travel:

Never or rarely

Up to 25% of the time

Up to 50% of the time

Up to 75% of the time

Up to 100% of the time

I am willing to relocate:

Yes

No

I am available to work the following days of the week:

 

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

I want to work the following shifts:

 

Not Applicable

Day

Evening

Night

Compressed

Rotating

Any

I want to work hours per week

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?

Yes

No

If yes, when?
Have you ever been convicted of a felony?

Yes

No

If yes, explain:

Education

High School:
Address:
From:
To:
Did you graduate? Yes No
Diploma:
College:
Address:
From:
To:
Did you graduate? Yes No
Degree:
Other:
Address:
From:
To:
Did you graduate? Yes No
Degree:

References

Please list three professional references.

Full Name:
Relationship:
Company:
Phone
Address:

Full Name:
Relationship:
Company:
Phone
Address:

Full Name:
Relationship:
Company:
Phone
Address:

Previous Employment

Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:$
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?

Yes

No

 

Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:$
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?

Yes

No

 

Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:$
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?

Yes

No

Disclaimer and Signature

By clicking submit

I certify that my answers 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.