Application
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Date
Name:
Address:
City, State, Zip
Social Security #:
Date of Birth (mm/dd/yyyy):
Driver License #
State:
Expiration Date:
Cell Phone #:
Home Phone #:
Email Address:
If you are under 18 years of age can you provide a work permit?
Yes
No
If no please explain
Are you a citizen of the United States?
Yes
No
If not, are you legally allowed to work in the United States?
Yes
No
Have you ever pleaded guilty, no contest or been convicted of a crime?
Yes
No
If yes give dates and details:
Answering yes to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.
Employment History. Please list employment for the last 5 years.
Employer Name:
Address:
City, State, Zip
Phone #:
Phone #:
Supervisor Name:
May we contact this employer for Reference?
Yes
No
Employer Name:
Address:
City, State, Zip
Phone #:
Supervisor Name:
May we contact this employer for reference?
yse
No
Employer Name
Address:
City, State, Zip
Phone #:
Supervisor Name:
May we contact this employer for reference?
Yes
No
Employer Name:
Address:
City, State, Zip
Phone #:
Supervisor Name:
May we contact this employer for reference?
Yes
No
I certify that my answers are true and complete to the best of my knowledge and that I am the applicant. I authorize you to make such investigations and inquiries of my personal employment, educational, financial and other related matters as may be necessary for an employment decision. I hereby release employers, schools or individuals from all liability when responding to inquires in connection with my application. I give permission to RT Auto Glass Inc., the right to obtain a Credit Rating Report and to perform a State and National Background Check. In the event I am employed, I understand that false or misleading information given in my application or interviews(s) may result in discharge. Please type your name and date as proof of applicant.
