Job Application – PDQ Mechancial

Personal Information

Name*

First Last

Date of Birth*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

How did you hear about our company?

Employment Information

Citizenship/Work Status:*

U.S. Citizen
Green Card Holder
U.S. Work Permit/Visa
Canadian Citizen
Canadian Work Permit/Visa

Current Employer: (if any)

Years of Work Experience directly related to the position you are applying for:*

Employment Type Desired:*

Full-Time
Part-Time

Desired Compensation: $*

Hourly
Annual

Other Compensation Desired:

When are you available to start working?*

Education

Type of School Completed:

High School
College/University
Business or Trade School
Professional School

High School Name:

Location:

# of Years Completed:

College/University Name:

Location:

# of Years Completed:

Major and Degree:

Business or Trade School Name:

Location:

# of Years Completed:

Major and Degree:

Professional School Name:

Location:

# of Years Completed:

Major and Degree:

Criminal History

Have you ever been convicted of a felony or misdemeanor (except any minor traffic violations)?*

Yes
No

Please explain and attach any relevant documentation:

Documentation:

Drop files here or

Drivers License Information

Do you have a valid driver's license?*

Yes
No

Do you have reliable transportation to work (please be specific)?*

Driver's License Number:*

State of Issue:*

Do you have a clean driving record?*

Yes
No

List any Moving Violations and/or Accidents from the last 3 year:

Miltary Service

Have you ever been in the armed forces?*

Yes
No

Branch:

Are you currently a member of the national guard or reserves?*

Yes
No

Specialty:

Date Entered:

Discharge Date:

Work Experience

Name of Employer:

Address of Employer:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Last Supervisor

First Last

Employment Dates:

Pay or Salary:

Job Title:

Specific Reason for Leaving:

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

May we contact this employer?

Yes
No

Name of Employer:

Address of Employer:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Last Supervisor

First Last

Employment Dates:

Pay or Salary:

Job Title:

Specific Reason for Leaving:

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

May we contact this employer?

Yes
No

Professional References

Reference #1

Name

First Last

Position

Company

Phone

Email

Reference #2

Name

First Last

Position

Company

Phone

Email

Reference #3

Name

First Last

Position

Company

Phone

Email

Reference #4

Name

First Last

Position

Company

Phone

Email

Did you complete this application yourself?*

Yes
No

Who did?

Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying. If you have a resume, please include it with this application.

Resume: