Application for Employment

We are committed to a policy of Equal Employment Opportunity and will not discriminate on any legally recognized basis, including but not limited to race, age, color, religion, marital status, national origin, citizenship, ancestry, physical or mental disability, veteran status or any other legally protected basis.

Position Applying For(*)

Personal Background

First Name(*)

Middle Name(*)

Last Name(*)

Present Address(*)

City(*)

State(*)

Permanent Address

City

State

Home Phone(*)

Message Phone

Referred By

Start Date

Desired Salary

Are you employed?(*) YesNo

May we contact your present employer?(*) YesNo

Have you applied at Dekra-Lite before?(*) YesNo

Where

When

Are you willing to work overtime?(*) YesNo

US Military or Naval Service

Rank

If driving is a requirement of the position for which you are applying, do you have a current, valid driver's license?(*) YesNo

Driver's License Expiration Date

If a minor, can you obtain a work permit?(*) YesNo

Are you legally eligible for work in the U.S.? Verification and completion of the 1-9 form must be submitted no later than three business days after the date of hire.(*) YesNo

Have you ever been convicted of a felony? (A conviction record will not necessarily disqualify you for employment)(*) YesNo

If so, please describe fully the nature of the conviction(s) and your rehabilitation since then.

Educational Background

Name of High School and Location

Highest Grade Complete 9101112GED

Name of College and Location of School

Number of Years Completed 1234

Major area of study

Name and Location of Trade, Business, or Graduate School

Major Area of Study of Trade, Business or Graduate School

Special Technical Skills

Computer programmer/language, equipment operation, special tools or machines used

Work Experience

(List below your last four employees, starting with your present or last place of employment.) You may include in such history any verified work performed on a volunteer basis.

From

To

Name and Address of Employer

Salary

Position

Name of Supervisor

Reason for leaving

From

To

Name and Address of Employer

Salary

Position

Name of Supervisor

Reason for leaving

From

To

Name and Address of Employer

Salary

Position

Name of Supervisor

Reason for leaving

From

To

Name and Address of Employer

Salary

Position

Name of Supervisor

Reason for leaving

References

Please list three persons, not related to you, whom you have known for at least three years.

Name

Occupation

Address

Phone Number

Years Known

Name

Occupation

Address

Phone Number

Years Known

Name

Occupation

Address

Phone Number

Years Known

Applicants Statement

In signing this application, I certify that all of the following information is a complete and accurate statement of the facts and understand that if any misrepresentation, omission or falsification be discovered, it will constitute grounds for dismissal. I hereby authorize Dekra-Lite to conduct any investigation necessary concerning any part of my background related to the position I am seeking. I release all parties from any liability in connection with provision and use of such information. I understand and agree that, if employed by Dekra-Lite, I will abide by its regulations which I understand are subject to change. I further understand that if hired, my employment is for no definite period of time and may be terminated by either party at any time.

Please type your full name to signify acceptance

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