Careers – EBA Automotive

Applicant Information

First Name

Last Name

M.I

Date of Birth

Street Address

Apartment/Unit #

City

State

Zip Code

Phone Number

Date Available

Desired Salary

Social Security No.

Position Applied for

Are you legally eligible to work in the U.S.?

Yes No

Have you ever worked for this company?

Yes No

If yes, when?

Have you ever been convicted of a felony?

Yes No

If yes, explain.

Education

High School

Address

From

Did you graduate?

Yes No

Degree

College

Address

From

Did you graduate?

Yes No

Degree

Other

Address

From

Did you graduate?

Yes No

Employment History

Company

From

Address

Phone Number

Supervisor

Responsibilities

May we contact?

Yes No

Company

From

Address

Phone Number

Supervisor

Responsibilities

May we contact?

Yes No

Company

From

Address

Phone Number

Supervisor

Responsibilities

May we contact?

Yes No

You give us permission to complete a full background check on you.

Yes No

You consent to random drug testing.

Yes No

References

Full Name

Relationship

Phone Number

Full Name

Relationship

Phone Number

Full Name

Relationship

Phone Number

Disclaimer and Signature

I certify that the information contained in this application is correct to the best of my knowledge. I understand that to falsify information is grounds for refusing to hire me, or for discharge should I be hired.

I authorize any person, organization or company listed on this application to furnish you any and all information concerning my previous employment, education and qualifications for employment. I also authorize you to re-quest and receive such information.

In consideration for my employment, I agree to abide by the rules and regulations of the company, which rules may be changed, withdrawn, added or interpreted at any time, at the company’s sole option and without prior notice to me.

I also acknowledge that my employment may be terminated, or any offer or acceptance of employment withdrawn, at any time, with or without cause, and with or without prior notice at the option of the company or myself.

Signature (Name)

Date

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