Position(s) applied for
Date
First Name
Last Name
Address
City
State
Phone
Email
Social Security #
Please give the appropriate response, where indicated
How did you hear about this position
If necessary, the best time to call you at home is
May we contact you at work?
Have you ever filed an application here or at any other Community Tire location before, and if so, where and when?
Where
When
Have you been employed by Community Tire before?
From
To
Do you have a family member employed by Community Tire?
If yes, at which location are they employed?
Are you eligible for employment in this country?(Proof of U.S. citizenship or immigration status will be required upon employment)
Minimum salary requirement:
Date available to work:
Full Time/Part Time:
Are you willing to work overtime if required?
Have you ever been convicted of a felony?
Have you ever been convicted of any crime involving theft or dishonesty?(A conviction will not necessarily disqualify an applicant from employment.)
if yes, please explain
if yes, please explain
Driver’s License Number
State issued
Is your license current
If you have any traffic violations on your driving record please explain
Employment History - please note: Resumes are welcome, but cannot be used as a substitute for the information below.
List your employers, during the past 10 years, starting with the most recent. Please explain gaps in employment in the comments section below.
Employer
Phone #
Dates employed
From
To
Summarize the type of business and your position responsibilities:
Address:
City
State
Zip
Position title
Immediate supervisor & title
Starting hourly rate/salary
Final hourly rate/salary
May we contact supervisor for reference
Reason for leaving
Employer
Phone #
Dates employed
From
To
Summarize the type of business and your position responsibilities:
Address:
City
State
Zip
Position title
Immediate supervisor & title
Starting hourly rate/salary
Final hourly rate/salary
May we contact supervisor for reference
Reason for leaving
Employer
Phone #
Dates employed
From
To
Summarize the type of business and your position responsibilities:
Address:
City
State
Zip
Position title
Immediate supervisor & title
Starting hourly rate/salary
Final hourly rate/salary
May we contact supervisor for reference
Reason for leaving
Comments section (including explanation of any gaps in employment)
Educational Background and Skills
Skills and qualifications: Summarize business skills, computer knowledge, languages, equipment used or other experience, which may qualify you to work with our company (attach additional sheets if necessary).
References
List three professional references other than prior employers we may contact
NAME
TITLE
PHONE #
Did a current Community Tire employee refer you for Community Tire employment?
If yes, who
I hereby certify that the information contained in the application is true and correct to the best of my knowledge and agree to have any of the information contained in this application verified by Community Tire unless I have indicated in writing to the contrary. I authorize the references listed above, as well as, all other individuals whom Community Tire contacts, to provide any and all information concerning my previous employment and any other pertinent information they may have. Further, I release all parties and persons from any and all liability for any damages that may result from furnishing such information to Community Tire as well as from the use or disclosure of such information by Community Tire or any of its agents, co-workers or representatives. I understand that any misrepresentation, falsification or material omission of information on this application may result in my failure to receive an offer or, if I am hired, my immediate dismissal from employment.
In consideration of my employment, I agree to conform to the rules and standards of Community Tire. I further agree that my employment is not for any specific time period and my employment can be terminated at-will, with or without cause and with or without notice, at any time, either at my option or at the option of Community Tire. I also acknowledge that no written or oral promise of employment for a specific term is effective unless expressly signed by the Vice President or Human Resources Manager.
By filling in your name you are digitally signing this document
Date
