PERSONAL INFORMATION Name (last, first and middle) Present address City State ZIP Code Permanent address (if different) City State ZIP Code Email address Phone number Cell Phone number Are you 18 years of age or older?Yes No After employment, can you provide proof that you are allowed to work in the US?Yes No EMPLOYMENT DESIRED Position Date you can start Salary desired Available to workFull time Part time Are you employed now?Yes No If yes, may we inquire of your present employer?Yes No Who referred you to our Company? Have you ever worked for us before?Yes No If yes, where? If yes, when? Exact reason(s) for leaving Name of last supervisor at our Company FORMER EMPLOYERS Your last four employers, starting with the most recent 1. Name/Address Start Date Final Date Start Salary Final Salary Title/Position Description of work Reason for leaving TerminationVoluntary Involuntary Supervisor May we contact?Yes No Phone # 2. Name/Address Start Date Final Date Start Salary Final Salary Title/Position Description of work Reason for leaving TerminationVoluntary Involuntary Supervisor May we contact?Yes No Phone # 3. Name/Address Start Date Final Date Start Salary Final Salary Title/Position Description of work Reason for leaving TerminationVoluntary Involuntary Supervisor May we contact?Yes No Phone # 4. Name/Address Start Date Final Date Start Salary Final Salary Title/Position Description of work Reason for leaving TerminationVoluntary Involuntary Supervisor May we contact?Yes No Phone # EDUCATION HISTORY High School Name & Location # Years Attended Did you graduate? Major/Minor Studied College Name & Location # Years Attended Did you graduate? Major/Minor Studied Graduate School Name & Location # Years Attended Did you graduate? Major/Minor Studied Trade School Name & Location # Years Attended Did you graduate? Major/Minor Studied MILITARY SERVICE Describe any military service skills that may be relevant to the job you are applying for OTHER SKILLS, QUALITIES OR CHARACTERISTICS Describe any other skills, qualities or characteristics that you possess which would be valuable to Naples Island Car Wash PERFORMANCE OF JOB-RELATED FUNCTIONS Are you able to perform the essential functions of the job for which you are applying with or without accomodation? Yes No REFERENCESThree people not related to you, that you've known for at least one year Reference #1 Name Address Phone Business Years Known Reference #2 Name Address Phone Business Years Known Reference #3 Name Address Phone Business Years Known AUTHORIZATION Before sending your questionnaire, please take a moment to make sure you have completed all of the questions. Failure to complete all of the questions may delay or prevent the processing of your questionnaire. By pressing the button below you are agreeing to all of the following: I declare under penalty of perjury that the information contained in this questionnaire is true and complete to the best of my knowledge.I understand that any false information or significant ommissions will disqualify me from further consideration for employment, and will be justification for my dismissal from employment, if discovered at a later date.I agree to immediately notify the Company if I should be convicted of any crime while my job questionnaire is pending or during my period of employment, if hired.I give permission for a pre-employment drug screening exam.I give permission for a complete employment background check.I consent to the appropriate release of any and all medical information, as may be deemed necessary.I understand that, if hired, I may be required to sign a company arbitration agreement.I understand that, if hired, I may not hold other employment unless given permission in writing by the Company.Agreement for At-Will EmploymentI understand and acknowledge that my employment will be at-will, and may be terminated with or without cause, and with or without notice, at any time at the option of myself or the Company. Only the President of the Company has the authority to enter into an employment agreement for a specified period of time or for the termination only for cause, and any such agreement must be in writing. Except to the extent I am covered by such a written agreement, I understand and acknowledge that this constitutes the entire agreement between me and the Company regarding the term of my employment and supercedes any other oral or written agreement. Compliance With RulesIf I become employed, in consideration of my employment, I understand that I must comply with the rules, regulations, policies and procedures of the Company.ReleaseI authorize the investigation of all statements contained in the Pre-Employment Questionnaire form and further authorize any person, school, current employer (except as expressly noted), past employer(s), and organizations named in the Pre-Employment Questionnaire form to provide the Company with records, information, and opinion that may be useful in making a hiring decision. I release all informants from all liability for any damage that may result from furnishing information and opinion (which is truthful or made in good faith) to the Company.
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