Employment

Name

Address

Apt/ Unit#

City

State

Zip

Email

Phone

Area of Interest

Joining our team as an Appliance Repair Technician Office Staff Customer Service Department

Are you willing to relocate?

Yes No

Military Experience
If no military experience please skip to next section

Branch of Service

Specialty

Description of work/ experience:

Date of enlistment: (mm/dd/year)

Date of discharge: (mm/dd/year)

Position Desired

Salary Desired

Are you presently employed?

Yes No

If yes, may we inquire with your present employer?

Yes No

Have you ever applied at All Pro Appliance Service, Inc. company before?

Yes No

If yes, where?

When?

Have you ever worked at All Pro Appliance Service, Inc. company before?

Yes No

If yes, when?

What was your reason for leaving?

List the schools you have attended.

High School:

Name:

Location:

Years you attended this school:

Did you graduate?

Yes No

University/College:

Name:

Location:

Years you attended this school:

What did you study?

Did you graduate?

Yes No

Trade Schools or other schools attended:

Name:

Location:

Years you attended this school:

What did you study?

Did you graduate?

Yes No

Driving Record

Do you have a clean driving record?

Yes No

If no, please explain:

Please list your last three employers, starting with the most recent or current employer.

Present / Last Employer:

Phone:

Address:

City

State

Zip

When were you employed?

From:

To:

Job Title:

Salary:

Name of Supervisor:

May we contact your supervisor?

Yes No

Description of Work:

Reason for Leaving:

Previous Employer:

Phone:

Address:

City

State

Zip

When were you employed?

From:

To:

Job Title:

Salary:

Name of Supervisor:

May we contact your supervisor?

Yes No

Description of Work:

Reason for Leaving:

Previous Employer:

Phone:

Address:

City

State

Zip

When were you employed?

From:

To:

Job Title:

Salary:

Name of Supervisor:

May we contact your supervisor?

Yes No

Description of Work:

Reason for Leaving:

Have you ever been convicted of a felony within the last five years?

Yes No

If yes, please explain:

A "yes" answer will not necessarily disqualify you from consideration.

Authorization

I understand that the foregoing is a preliminary questionnaire and that, prior to being considered for employment, I will be required to complete an application.

I certify that the facts contained in this application are true and complete the best of my knowledge, and I understand that, if employed, falsified statements on this questionnaire shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and I release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.