Employment Opportunities

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
Are you currently laid off of another job and can be called back to work?:	Yes:   No:
Are you currently employed?	Yes:   No:
If so by whom?:
Do you have any relatives currently working at Dick Smith Automotive Group (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 Dick Smith Automotive Group?:	License1:
	License2:
	License3:
List job-related professional or technical organizations to which you belong:	Organization1:
	Organization2:
	Organization3:
List Equipment you can operate relative to the job you are applying for:	Equipment1:
	Equipment2:
	Equipment3:
General Information
What do you expect to be doing in 5 years?:
Based on today's prices and wages, what monthly income do you expect to be earning in 5 years?:
What has been your most interesting work?
What made it so interesting?
What work experience did you dislike most?
Why did you dislike it?
Have you ever been convicted of a felony?:	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:

By sending in this E-mail form, I certify that all information submitted in this application form, or in any resume, interview, or other information, is true and complete and that I have not knowingly withheld, nor will I withhold, any information that would affect my application for employment.

I understand that employer is under no obligation to consider or reconsider this application at any time, and that acceptance of my application does not constitute an offer of employment. I also understand and agree that:

1. Inquiries may be made with my previous employers or others who I may have knowledge of m, or with consumer credit, investigative, or other private or governmental agencies. I authorize any such person or agency to give you any and all information concerning my previous employment, including but not limited to, an assesmen of my job performance, ability, and fitness, and/or any other information they may have, personal or otherwise, and release all parties from any and all liability, claims, or damages that they may directly ot indirectly result from furnishing same. Upon my reasonable and timely request, a description of the general scope and nature of any such inquiry will be provided to me.

2. Prior to my beginning work or during my employment, employer reserves the right to require ant lawful form of medical, drug, alcohol, psychological, character, honesty, integrity, aptitude, skill, or other test or examination.