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This form has been designed to strictly comply with state and federal fair employment practice laws prohibiting discrimination. All qualified applicants will receive equal consideration for employment without regard to race, religion, color, sex, national origin, age, military background, handicap, marital status, height, weight, or arrest record.

Email Address
From To
From To
  City Zip        

In case of Emergency Notify

Ever applied to this company before?
If related to anyone in our company, give name and

    If no, do you have a permit to work here.?

Do you have a driver's license?
Has you operator's permit ever been revoked or restricted?
Have you been in an auto accident in the past three years?
Have you ever been refused surety bond?
Have you ever been convicted of a crime?
Have you ever been discharged or required to resign from a position?
Are you on a lay-off and subject to recall?

Work Time Lost Last Year Due To Tardiness or Absenteeism

Date of Discharge

Show Actual Experience By Selecting All The Following That Apply:

If applicable, check in which areas of repair you are certified:

State Certification
Expiration date:

have you been certified by the National Institute for Automotive Service Excellence (NIASE) Yes No
Any notice of non-compliance? Yes No

Number of years
High School
Grad School


Employment Dates

Name and Address of Employer Position or Title Supervisor's Name Salary Received Reason for Separation

Have you recently signed a non-disclosure or non-compete agreement with your current employer or any past employers? Yes No

If yes, please explaing

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Applicant's Certification, Authorization, and Acknowledgement

I certify that the facts set forth in this employment application are true and complete to the best of my knowledge. I understand that if employed, false statements on this application may subject me to dismissal. You are authorized to make an investigation of my employment history and my personal history through any investigative agencies or bureaus of your choice, and to contact my current and any of my former employers and I give such employers the right to release to you all records of my employment (excluding medical records) including assessments of my jog performance, ability and fitness. I understand that you may require a motor vehicle record report and authorize you to obtain said report. I understand that you reserve the right to require that an offer of employment is conditional upon the results of a medical examination including but no limited to any drug screening tests, including alcohol. I understand that you reserve the right to require drug screening tests, including alcohol, at any time during employment. If employed, I understand that if I need an accommodation for a handicap under the state and federal laws, I must notify the employer in writing of my need for an acclamation within 182 days after I know of should have known that I need that accommodation and my failure to provide that notice will prevent me from claiming that my employer failed to accommodate my handicap under law. this requirement does not waive an individual's rights under the Americans With Disabilities Act. I further understand tat the use of this form does not indicate that there are any positions open and does not in any way obligate this company. This application is current for ninety (90) days. At the conclusion of this time, if I have not been employed by this company and still wish to be considered for employment, it will be necessary for me to fill out a new Application. Further, I understand and agree that if I am hired by this company, unless specifically set forth in writing to the contrary and signed by the company and myself, my employment will for for no definite period, and may, regardless of the date of payment of my wages or salary, be terminated at any time for any reason at the will of the dealership with out any previous notice.

I am willing to sign this and date it. Yes No


4625 E Gage Ave  ::  Bell, CA 90201  ::  (323) 771-3429  Fax: (323) 771-6464