APPLICANT INFORMATION

Name

Phone

(###)

###

####

Are you able to perform the functions of the position without accommodations?

Yes

Are you legally eligible for employment in the United States?

Yes

If hired, would you be available to work overtime when required?

Yes

Have you been convicted of any felonies other than minor traffic violations in the last seven (7) years?

Yes

If yes, please explain:

Describe a specific situation where you have provided excellent customer service in your most recent position. Why was this effective?

EMPLOYMENT HISTORY

List most recent employment first. Be sure all your experience or employers related to the job to which you are applying is listed here. No more than 10 years history recommended.

Job #1

Employer Name

Employer Address

Supervisor

Phone

(###)

###

####

Start Date

YYYY

End Date

YYYY

Starting Salary

Ending Salary

Position Title, Duties, and Skills

Reason for leaving

Job #2

Employer Name

Employer Address

Supervisor

Phone

(###)

###

####

Start Date

YYYY

End Date

YYYY

Starting Salary

Ending Salary

Position Title, Duties, and Skills

Reason for leaving

Job #3

Employer Name

Employer Address

Supervisor

Phone

(###)

###

####

Start Date

YYYY

End Date

YYYY

Starting Salary

Ending Salary

Position Title, Duties, and Skills

Reason for leaving

EDUCATION

High School

Institution Name / Dates Attended / Graduate or GED

College / Univeristy

Institution Name / Dates Attended / Field of Study / Graduate or Degree

Business / Technical

Institution Name / Dates Attended / Field of Study / Graduate, Certificate, or Degree

Additional Education

Institution Name / Dates Attended / Field of Study / Graduate or Degree

Military Service

Are you a veteran?

Yes

Occupation / Specialized Training

SKILLS & QUALIFICATIONS

Other qualifications such as special skills, abilities or honors that should be considered

Types of computer software that you are familiar with

Additional skills, including supervision skills, other languages or information regarding the career/occupation you wish to bring to the employer’s attention

Typing Speed - Words Per Minute

Click here for a free typing test

REFERENCES

List two personal references who are not relatives or former supervisors, whom you have known for at least one year.

Reference #1

First Name

Last Name

Phone

(###)

###

####

Relationship

Years Known

Reference #2

First Name

Last Name

Phone

(###)

###

####

Relationship

Years Known

EMERGENCY CONTACT

First Name

Last Name

Relationship

Years Known

INFORMATION TO THE APPLICANT

As part of our procedure for processing your employment application, your personal and employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may make a written request for information derived from the checking of your references.

If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the United States, have a physical examination and/or a drug test, or to sign a conflict of interest agreement and abide by its terms. I understand and agree to the information shown above.

ELCTRONIC SIGNATURE

DATE

YYYY

I am most interested in the...

Warehouse Position

Sales Position

Any Position

Thank your for your interest in employment with Diesel Performance Parts. If what you have sent us matches our current needs, you can expect to hear from us shortly.

-Mark Craig

Owner & Operator

JOB APPLICATION

Hours