Online Employment Application

Balise is always looking for qualified associates to work in our friendly and professional environment. Please take a few minutes to fill out this application form if you would be interested in becoming part of the Balise team.

If you prefer, you can print the form and fax it to us at 413-739-5826, attention Bob Martin, HR Generalist, or mail it to:

Bob Martin, HR Generalist
Balise Motor Sales Co.
122 Doty Circle
West Springfield, MA 01089

Please feel free to also include your resume.

Contact Information

Your Name:

Internet E-Mail:

Home Phone:

Address:

City:

State:

Zip:

Soc. Security #:

Position Information

Position you are interested in:

Are you interested in: Full Time: Part Time: Temporary:

What days and hours are you available?:

What pay do you expect?:

When can you start work?:

Current Status Information

Do you have a current valid Driver's License?: Yes: No:

If so which state?:

Are you currently employed? Yes: No:

If so by whom?:

Have you ever been employed at Balise before? Yes: No:

If so what position and what dates were you employed?:

Do you have any relatives currently working at Balise? (will not necessarily disqualify employment): Yes: No:

If yes, please list their names: Employee1:

Employee2:

Employee3:

Education Information

Did you graduate high school?: Yes: No:

Did you graduate college?: Yes: No:

If so, what college?:

If you didn't graduate college, how many years did you attend?:

1 Year: 2 Years:

3 Years: 4 Years:

More than 4 Years:

Did you attend a technical college?: Yes: No:

If so, what school?:

Please list any licenses or certificates relative to employment with Balise: License1:

License2:

License3:

List equipment you can operate relative to the job you are applying for: Equipment1:

Equipment2:

Equipment3:

General Information

Have you ever been convicted of a felony or misdemeanor in the last 5 years, with the exception of a first conviction for drunkenness, simple assault, speeding, minor traffic violations, affray or disturbance of peace?: Yes: No:

If yes, explain. (Conviction will not necessarily disqualify.)

Can you, if employed, submit verification of your right to work in the United States? Yes: No:

Employment History - Position 1

List Present and Past Employers, MOST RECENT FIRST. Personal references may be listed following employment history, please no relatives.

Employer:

Address:

Phone:

Fax:

Position:

Start Date:

Termination Date:

Supervisor:

Starting Salary:

Ending Salary:

Duties:

Reason for leaving:

Additional Comments:

Employment History - Position 2

Employer:

Address:

Phone:

Fax:

Position:

Start Date:

Termination Date:

Supervisor:

Starting Salary:

Ending Salary:

Duties:

Reason for leaving:

Additional Comments:

Employment History - Position 3

Employer:

Address:

Phone:

Fax:

Position:

Start Date:

Termination Date:

Supervisor:

Starting Salary:

Ending Salary:

Duties:

Reason for leaving:

Additional Comments:

Employment History - Position 4

Employer:

Address:

Phone:

Fax:

Position:

Start Date:

Termination Date:

Supervisor:

Starting Salary:

Ending Salary:

Duties:

Reason for leaving:

Additional Comments:

Applicant's Certification and Agreement
I hereby certify that the facts set forth in the above application are true and complete to the best of my knowledge. I understand that any false answers or statements or implications made by me in this application or other documents shall be considered sufficient cause for denial of employment or discharge.

I thereby give Balise the right to make a thorough investigation of my past employment, education and training which would include the verification of the information set forth on this application of employment. I release from all liability, all persons, companies and corporations supplying such information. I indemnify Balise against any liability which might result from making such an investigation.

I also understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract. Any offer of employment is contingent upon undergoing verification of information obtained during the interviewing process, satisfactory reference checks, completion and passing a pre-employment drug test.

All Balise associates are associates at will, which means that both Balise and it's associates are free to terminate the employment relationship at any time and at the sole discretion of either party. I understand that no Balise Supervisor or other associate has the authority to alter the nature of this employment relationship.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Signature:

Date: