GET A JOB WITH MYERSTOWN, PA’S BEST GARAGE DOOR SELLER TODAY! Personal InformationName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Age (if under 18) Are you prevented from lawfully becoming employed in this country because of visa or immigration status?* Yes No Employment DesiredPosition* Start date* MM slash DD slash YYYY Salary Desired * Are you employed now?* Yes No If so may we inquire of your present employer? Yes No Referred by EducationHigh School* Please state name & location of school. Also include year graduated.College* Please state name & location of school. Also include year graduated.Business/Trade School* Please state name & location of school. Also include year graduated.Criminal RecordHave you ever been convicted of a crime?* Yes No If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.ReferencesName* Phone* Business* Name* Phone* Business* Driver's InformationDo you have a driver's license?* Yes No What is your means of transportation to work? * Number of accidents during past 3 years?* Number of driving violations during past 3 years? Former Employer #1Employer Name* Job Title* Time Length Employed* Reason for leaving* Supervisor Name* Phone* Duties & Responsibilities*Former Employer #2Employer Name* Job Title* Time Length Employed* Reason for leaving* Supervisor Name* Phone* Duties & Responsibilities*Former Employer #3Employer Name* Job Title* Time Length Employed* Reason for leaving* Supervisor Name* Phone* Duties & Responsibilities*Former Employer #4Employer Name* Job Title* Time Length Employed* Reason for leaving* Supervisor Name* Phone* Duties & Responsibilities*CitzenshipWe hire only U.S. Citizens and lawfully authorized alien workers. If a conditional offer of employment is made, you will be required to provide identification and proof of citizenship or authorization to work in the U.S.Are you a U.S. Citizen or are you legally authorized to work in U.S.?* Yes No Selective Service System RegistrationAll males between the ages of 18 and 25 must be registered with selective service system or exempted.If you are a male between the ages of 18 and 25, do you have proof of registration with the selective service system or exemption from such registration? Yes No CertificationI am aware that any omissions, falsifications, misstatements or misrepresentations above may disqualify me for employment consideration and, if I am hired, may be grounds for termination at a later date. I understand that any information i give may be investigated as allowed by law. I consent to the release of information about my ability, employment history, and fitness for employment by employers, schools, law enforcement agencies, and other individuals and organizations to investigators, personnel staff, and other authorized employees for employment purposes. This consent shall continue to be effective during my employment. If I am hired, I certify that to the best of my knowledge and belief all of the statements contained herein and on any attachments are true, correct, complete and made in good faith.Signature* Type Full NameDate* MM slash DD slash YYYY Email* Employment Application
