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Lou Bachrodt Employment Application

NameType your full name:

Current AddressStreet Address:

City:

State:

Zip Code:

How Long?

Best Time to CallTime/ Day or evening?

PhoneBest contact number:

*Please provide address information for the past 10 years.
If you have lived at your current address for 10 years or more, enter N/A.

Previous Address (1)Street Address:

City:

State:

Zip Code:

How Long?

*Please provide address information for the past 10 years.
If you have lived at your current address for 10 years or more, enter N/A.

Previous Address (2)Street Address:

City:

State:

Zip Code:

How Long?

Previous Address (3)Street Address:

City:

State:

Zip Code:

How Long?

Previous Address (4)Street Address:

City:

State:

Zip Code:

How Long?

Have you ever APPLIED TO our company?

If yes, when/position?

Have you ever WORKED FOR our company?

If yes, when/position?

Specify position if not listed:

Were you referred by a Team Bachrodt employee?

If yes, enter name below

SalaryEnter your expected earnings:

Are you interested in? (check all that apply)

Days available to work

Hours

Date available to work

Are you presently employed?

If yes, may we contact your present employer?

Preferred work location

If offered employment, can you submit verification of your right to work in the U.S.?

Have you ever been known by any other name?

List other names or aliasesIf you answered no, enter N/A below

Can you drive a stick shift/manual vehicle?

Driving RecordIf a driver's license is required for the position for which you are applying, do you have a valid driver's license with less than 3 violations in the past 3 years?

Expiration DateMM/DD/YYYY

Some Title

Some Title

Some Title

Employment History

List below all current and former employers for the past ten (10) years, beginning with the most recent. Account for ALL periods between jobs, providing a detailed explanation. DO NOT WRITE “SEE RESUME”

Have you ever been terminated or asked to resign from any job?

If yes, please explain the circumstances

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If employment was under a different name, indicate below

Company (1)

Job Title

Duties

From (Mo/Yr)

To (Mo/Yr)

Supervisors Name

Starting Salary

Ending Salary

Reason For LeavingIf presently employed, enter N/A below

Can we contact this employer?

Phone

Company (2)

Job Title

Duties

From (Mo/Yr)

To (Mo/Yr)

Supervisors Name

Starting Salary

Ending Salary

Reason For Leaving

Can we contact this employer?

Phone

Company (3)

Job Title

Duties

From (Mo/Yr)

To (Mo/Yr)

Supervisors Name

Starting Salary

Ending Salary

Reason For Leaving

Can we contact this employer?

Phone

Company (4)

Job Title

Duties

From (Mo/Yr)

To (Mo/Yr)

Supervisors Name

Starting Salary

Ending Salary

Reason For Leaving

Can we contact this employer?

Phone

Company (5)

Job Title

Duties

From (Mo/Yr)

To (Mo/Yr)

Supervisors Name

Starting Salary

Ending Salary

Field of Study/Major

Reason For Leaving

Can we contact this employer?

Phone

Education & Experience

Please indicate all levels of COMPLETED education.

High School Diploma/GED

Did you graduate?

Some College

Field of Study/Major

College

Did you graduate?

Degree

Trade School

Did you graduate?

Field of Study/Major

List certificates or licenses you hold, or specialized training you have completed that may help qualify you for employment:

0 /

List all equipment, you can operate, that may help you qualify for employment:

0 /

Additional Information

Please indicate any actual work experience you have in any of the following positions.

OFFICE EXPERIENCE

SALES & LEASING EXPERIENCE

SERVICE & REPAIR

PARTS

Other

References

Give the names of three (3) BUSINESS references other than those supplied in your employment history that have known you for at least two (2) years. Please DO NOT provide relatives or friends. Provide individuals who can speak to your professional ability. (for example: Managers, Supervisors, Co-Workers, Clients, Teachers, Students etc.)

Name (1)

Phone

Relationship

Years Known

Name (2)

Phone

Relationship

Years Known

Name (3)

Phone

Relationship

Years Known

Thank you for your interest in joining Team Bachrodt. If our application has not fully provided you with an opportunity to fully convey your skills for consideration, please use the space below to further express your thoughts.

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I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information on my application or interview may result in my release. My electronic signature below constitutes a legal signature confirming that I have acknowledged and agree to the above disclaimer.

Electronic SignatureType Your Full Name Here.

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