Application for Employment

Main Office: 2424 Professional Drive
Roseville, CA 95661

Today's Date:

PERSONAL DATA

*

Last Name

* First Name
* Present Address:
* City:
* State:
* Zip:
  Permanent Address: (if different from present)
  City:
  State:
  Zip:
* Home Phone:
  Message Phone:

POSITION DATA

  Position applied for:
  If hired, what date can you start work?
  Acceptable Salary Range:
  Availability:
Regular Full Time
Regular Part Time
Temporary Work
  From to
  What days and hours are you available for work?
  Are you available for overtime or work on weekends? +A37
YES NO
  Are you employed now?
YES NO
  If so, may we contact your present employer?
YES NO
  Applied to Cooks Collision before?
YES NO
  When?
  Worked for Cooks Collision before?
YES NO
  When and Reason for leaving?

PERSONAL INFORMATION
  If hired, can you present evidence of US citizenship or proof of legal right tolive and work in this country?
YES NO
  Are you at least 18 years old? (hire subject to verification of minimum legal age)
YES NO
  Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?
YES NO
  If no, describe the functions that cannot be performed:
  **Note we comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may by subject to passing a medical examinationm and to skill and agility tests.
  If hired, would you have a reliable means of transportation to and from work?
YES NO
  Do you have a valid driver's license?
YES NO State License No.
  Have you ever been convicted of a criminal offense (Felony or Serious Misdemeanor)?
YES NO
  If yes, state the nature of the crime(s), when and where convicted and disposition of the case.
  **Note no applicant will be denied employment solely on the grounds of criminal offense conviction. The nature of offense, date, surrounding circumstances and relevance of the offense to the position(s) applied for may, however, be considered.

EDUCATION AND TRAINING
 

School

Name & Address of School

No. of Years Completed

Did you Graduate?

Degree or Diploma
High School
YES NO
College/University
YES NO
Vocational, Business or Health Care School
YES NO
  Do you have any other experience, training, qualifications or skills which you feel make you especially suited for work at Cooks Collision? If so, please explain:
  Many of our clients do not speak English. Do you speak, write or understand any foreign languages? If yes, which language(s)?
  Answer the following questions if you are applying for a professional position:
  Are you licensed/certified for the job applied for?
YES NO
  Has your license/certification ever been revoked or suspended?
YES NO
  If yes, state season, date of revocation or suspension and date of reinstatement:
  Name of license/certification:
  Issuing state:
  License/certification number:

EMPLOYMENT HISTORY
  Resume Upload:
If you have a resume that you would like to upload,
please enter it using the box above
  List below all present & past employment (last 5 years is sufficient)
 

Dates of Employment Month & Year

Employer Name Telephone & Address

Position

Salary

Reason for Leaving

1) From
  To
2) From
  To
3) From
  To
4) From
  To
5) From
  To

REFERENCES
  List below 3 persons not related to you and who have knowledge of your work performance within the last 3 years:
 

Name & Occupation

Address & Telepone

No. of Years Acquainted & How Acquainted

1)
2)
3)

PLEASE READ CAREFULLY AND CHECK BOXES PROVIDED

*

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I have read and agree

 
*

I hereby authorize Cooks Collision to thoroughly investigate my references, work record, education, and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notce of such disclosure. In addition, I hereby release Cooks Collision, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

I have read and agree

 
*

I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and Cooks Collision. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or Cooks Collision, and that no promises or representations contrary to the foregoing are binding on Cooks Collision unless made in writing and signed by me and a designated representative of Cooks Collision.

I have read and agree

 
*

Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment) be conducted by internal personnel employed by Cooks Collision, I am entitled to copies of such public records obtained by Cooks Collision unless I mark the waive of receipt of public record below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have checked the waiver below.

I have read and agree

 
 

I waive receipt of any public record described in the paragraph above.

Waiver

Please ensure your application is complete and correct prior to submitting.