APPLICATION FOR EMPLOYMENT

Transcription

1 Lupient Buick/GMC of Rochester 4646 Highway 52 North Rochester, MN Phone: (507) Fax: (507) APPLICATION FOR EMPLOYMENT An Equal Opportunity Employer We are an equal opportunity employer, and we do not and will not discriminate on the basis of race, color, creed, religion, ancestry, national origin, age, sex, pregnancy, sexual orientation, marital status, veteran status, disability, membership or activity in a local commission or association or status with regard to public assistance, familial status or any other protected class identified under federal, state or local laws or ordinances. EMPLOYMENT INFORMATION Today s Date: Position Desired: Preferred Location(s): Date available to Start: Type of Work Desired: Full-Time Part-Time Temporary Willing to Relocate? Willing to Work: Weekends? Evenings? Overtime? Were you referred by a current Lupient employee? If so, who: Full Name: Present Address/City/State/Zip PERSONAL INFORMATION Permanent Address/City/State/Zip (if different from above) Social Security Number: - - Cell Phone Number: Address: Hometown: (If you are to be hired, your name and hometown will be added to your name badge.) Have you ever been known by another name? If yes, please provide the name(s)? Have you ever applied for a position with this Company in the past? If yes, please give the date and location in which you applied for. Has the Company ever employed you in the past? If yes, please give the dates of employment and the position(s) you held. Are you at least 18 years of age, or if under, do you have a permit to work? Are you eligible to work in the United States? Do you have a current, valid driver s license? Identify all states that you have held a license in the past ten years: Do you have any commitments that might affect your performance on the job(s) for which you are applying for? If yes, please explain: Are you able to perform the essential functions of the job? If no, are there reasonable accommodations that can be made to allow you to perform the essential job functions of the job? Describe those reasonable accommodations.

2 EMPLOYMENT RECORD List your three most recent employers. Include self-employment, summer, and part-time jobs. If more space is required, please continue on a separate sheet. You may attach your resume, but you must complete the application as well. Name Of Most Recent Employer Reasons for Leaving May we contact? Name Of Past Employer Reasons for Leaving May we contact? Name Of Past Employer Reasons for Leaving May we contact?

3 School Attended High School Technical, Vocational or Other Training EDUCATIONAL RECORD Name of School and Major Field of Location Study Circle highest grade completed All Did you Graduate? Degree/Diploma/ Certificate College or University JOB RELATED CERTIFICATES AND/OR SKILLS List any certificates, licenses, skills (other languages, computer programs, data entry speed, etc.) or qualifications that are relevant to the position(s) for which you are applying WORK REFERENCES List three people, not related to you, who have knowledge of your qualifications for the position(s) for which you are applying. Name Title/Relationship /City/State/Zip Telephone PLEASE READ CAREFULLY BEFORE SIGNING: I understand that completion of this Employment Application does not guarantee employment by the Company or create an actual or implied contract of employment. By signing below, I promise that the information provided in this employment application (and any related documents or interview) is true and correct. I expressly authorize the Company to obtain information concerning my education, employment experience and all other aspects of my background relevant to my proposed employment. I expressly authorize any person, school, current or prior employer named by me to provide any information or opinion requested by the Company, its agents and representatives in connection with my application, and I release all parties from liabilities in making such statements. I understand that any misrepresentation, or false or incomplete statement made in this application (and any related documents or interview) may result in my not being considered for employment, and if discovered by the Company after my becoming employed, regardless of when and how discovered, is grounds for, and may result in, my immediate termination. I also understand that hiring decisions may be made relating to the nature, timing, and other factors of my background as it relates to the job. Such decisions will be determined on a job-related, case-bycase basis. I understand that if I am hired, I am obligated to comply with all Company policies. I also understand that if I am hired, my employment is for no definite period and that it may be terminated at any time by either party, with or without cause and with or without prior notice. I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States. This Application for Employment is valid for 60 days from the date signed. I certify that I have read, fully understand, and accept the above terms. Signature: Date:

4 JOB APPLICANT/EMPLOYEE CONSENT FOR DRUG AND/OR ALCOHOL TESTING AND DRIVING RECORD PLEASE READ, SIGN, AND DATE THE FOLLOWING STATEMENT: RECEIPT OF COMPANY TESTING POLICY I acknowledge that I have received a copy of the Job Applicant Drug and/or Alcohol Testing Policy provided by Lupient Automotive Group/Lupient Enterprises/Midwest Maintenance s (the Company ). AUTHORIZATION STATEMENT I hereby consent to undergo drug and/or alcohol testing pursuant to the Company written policy along with the release of information within the Company and outside the Company as provided in Minnesota Law. I am aware that motor vehicle and consumer reports may be obtained as part of the Company evaluation of my job application and/or employment. The reports may be procured by the Company or its insurance company representative(s), and may include personal information obtained from state motor vehicle departments, my driving record, an assessment of my insurability for the insurance program, or other consumer reports. I understand that the Company will use these reports in accordance with the Drivers Privacy Protection Act (DPPA). By signing this form, I hereby provide my authorization for the Company or their insurance company representative(s) to procure such information and reports, as well as additional reports about me from time-to-time as deemed appropriate, to evaluate my insurability or for other permissible purposes. This authorization will be in effect until I advise the Company in writing that I wish to withdraw it. Signature of Applicant Driver s License Number Print Name As It Appears On Driver s License State of Issuance

5 DISCLOSURE AND AUTHORITY TO RELEASE INFORMATION Processed by: MCC Group, Inc Crosstown Circle, Suite #100 Eden Prairie, MN (952) The following named individual has made application with: Lupient Automotive Group Please PRINT complete legal name: Last First Middle Sex: F M Date of Birth / / Maiden/Former Month Day Year Drivers License State Social Security # Address City State Zip Previous Address City State Zip I understand that in processing my application with Lupient Automotive Group, an investigative consumer report may be conducted. FCRA 606.(a)(1) disclosure requirements; Any such background check report may contain information bearing on my character, general reputation, personal characteristics, mode of living and credit standing. Information may include, but is not limited to; employment history, education, criminal records, credit history, motor vehicle records, personal references, and any data provide on this application, or during the interview process. An investigative consumer report may be generated summarizing this information. I understand that before any adverse action is taken, based in whole or in part on the information contained in the consumer report, I will be provided a copy of the repot, a summary of my rights under the Fair Credit Reporting Act, as well as additional information on my rights under the law. I have a right under the Fair Credit Reporting Act and state law to obtain a copy of this report and the right to dispute any information, by providing proper identification and directing a written request to: Lupient Corporate Office, 7100 Wayzata Boulevard, Suite 200, Minneapolis, MN If employed in CA, MN or OK, I would like a copy of my report. Yes No This authorization is for this transaction only and continues in effect throughout your employment. It is understood that a photocopy or facsimile copy of this form will serve as authorization. Applicant s Signature Date Services Requested: DMV Credit Criminal Minnesota Kansas Missouri