Personal Information

Full Name
First		M.I.	Last
Address1
Address2
City, State	,	Zip Code:
Home Phone		Cell/Pager	Phone
Driver's License #		State of	Issuance
Email Address		Preferred	Start Date
Social Security #		Salary	Requirement $ /per month
If you are under age 18, can you provide a work permit? Yes No N/A		Have you previously worked for this company or any of it's subsidiaries? Yes No
Are you a citizen of the U.S.?  Yes No		If not a citizen of the U.S.? Are you legally allowed to work in the U.S.  Yes No N/A
What type of work are you looking for? Full-Time Part-Time  Temp Seasonal
Have you ever pled "guilty", "no-contest", or been convicted of crime? Yes No If yes, provide details:
Education
High School Name		City-State
Years Completed		Graduate?	Yes No
College or Trade School		City-State
Years Completed		Graduate?	Yes No

References
Reference 1 Name		Phone
Address
City, State	,	Zip Code:
Reference 2 Name		Phone
Address
City, State	,	Zip Code:

Employment History (start with most recent position) Company 1
Employed Dates	From: Thru:		Position Held
Company Name		Phone
Address
City, State	,	Zip Code:
Contact Name:		Title:
Describe Job Duties
Starting Salary	$ per month   Starting	Position
Ending Salary	$ per month     Ending	Position
Reason for Leaving
May we contact this employer for a reference.?  Yes No
Company 2
Employed Dates	From: Thru:		Position Held
Company Name		Phone
Address
City, State	,	Zip Code:
Contact Name:		Title:
Describe Job Duties
Starting Salary	$ per month   Starting	Position
Ending Salary	$ per month     Ending	Position
Reason for Leaving
May we contact this employer for a reference.?  Yes No
Company 3
Employed Dates	From: Thru:		Position Held
Company Name		Phone
Address
City, State	,	Zip Code:
Contact Name:		Title:
Describe Job Duties
Starting Salary	$ per month   Starting	Position
Ending Salary	$ per month     Ending	Position
Reason for Leaving
May we contact this employer for a reference.?  Yes No
Summary of Skills (ASE Certifications, etc)

By submission of this application I certify my answers are true to the best of my knowledge. I authorize Car Concepts, Inc. to make such investigations and inquiries of my personal, employment, educational, or medical history and other related matters as may be necessary for an employment decision. I hereby release employers, schools or persons from liability when responding to inquiries in connection with my application.

 In the event I am employed, I understand that false or misleading information given in my application or interview may result in discharge.