Employment Form

AL's Location*
Date*
MM slash DD slash YYYY
Your Name*
First Last
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Social Security Number (for identification purposes only)*
Date of birth*
MM slash DD slash YYYY
Driver's Licence Number*
Phone*
What is the Highest Level of Education that You've Completed?*
Previous Employment Information
Employer name
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor Name
First Last
Phone
Brief Job Description
Employer name
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor Name
First Last
Phone
Brief Job Description
Employer name
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor Name
First Last
Phone
Brief Job Description
Personal References: Please list 3 non-relatives information
Name
First Last
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name
First Last
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name
First Last
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Our normal business hours are Monday - Friday 8am - 6pm & Saturday 8am - 4pm.
Would you be available to work during these hours?
- Yes
- No
Please explain
Would you be able to perform the following tasks which are required for this job?
Lift 50 pounds, repeatedly
- Yes
- No
Work an 8 hour shift?
- Yes
- No
Have you had any accidents or driving citations within the past five years? If yes, explain
Please briefly list why you are seeking this position with our company and a goal you have for yourself in the long run
Al's Automotive Supply, Inc. is an "At Will" employer. Al's Automotive Supply, Inc. may terminate this relationship at any time, for any reason, with or without cause or notice.

At some point, you will be asked to take a drug test. By signing below, you are giving your consent to the random drug test. Also, by signing below, you assert that the information supplied on this form is accurate and complete. Any misinformation or omissions are grounds for denial of employment or subsequent discharge. Any offer and continuation of employment is subject to applicant's motor vehicle record meeting insurance company eligibility requirements.

Submitting this form also means you consent to Al's Automotive Supply performing a background check, including court record search, for the purpose of employment.
MOTOR VEHICLE RECORD REQUEST
Company Name: Al's Automotive Supply, Inc

Fax#: 618-337-2380

Phone #: 618-337-1364

Important: Do not allow new hires or potential hires to drive any autos until MVR information and approval to drive is received.
Al's Location
Date Sent
Driver Information:
Name
First Last
Driver's License Number
State
Date of Birth
MM slash DD slash YYYY
Job Description
Has the driver held a driver's license in another state in the last 3 years?
If yes, please explain:
AUTHORIZATION FOR COMPANY TO OBTAIN A DRIVER'S LICENSE REPORT

in compliance with the Fair Credit Reporting Act, we hereby notify you that for employment purposes, we may request a consumer report in connection with your application for employment or in connection with your employment. It is our normal practice to limit the consumer report to driving records available from the appropriate state departments or motor vehicles.

I voluntarily authorize Al's Automotive to obtain a consumer report for the purposes of business insurance underwriting. I acknowledge that Al's Automotive is not my employer or prospective employer and will not make any employment decision relating to me. I understand and agree that I can revoke this authorization only in writing and the revocation will be effective only upon receipt.
Driver's Signature
Date
MM slash DD slash YYYY

MOTOR VEHICLE RECORD REQUEST