931 Hamilton Drive Holland, Ohio 43528
Express Transmissions, Inc., Transmissions  Automobile, Holland, OH
419-861-8118

Employment Application

Programs, services and employment are equally available to everyone. Please inform the Human Resources Department if you require reasonable accommodation for the application or interview.

Applicant Information

Desired Position:

Referred by:

Full Name:

Address/City/State/Zip:

Phone:
Mobile:

Email:

Date Available to Start:

Social Security #:

If under 18 years of age, can you provide a work permit? YesNo If no, please explain:

Have you ever worked for this company? YesNo If yes, when?

Are you legally allowed to work in the United States? YesNo

Type of employment desired: Full-TimePart-TimeTemporarySeasonal

Have you ever pleaded guilty, no contest or been convicted of a crime? YesNo
If yes, give dates and details:
Answering yes to these questions does not constitute an automatic rejection for employment. Date of offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.

Driver's license #/State (if applicable to position):

Education History

Name & Location of High School: Did you graduate? YesNo

Name & Location of College: Years attended:
Degrees completed:
Other subjects studied:

Trade, Business or Correspondence School: Years attended:
Subjects studied: Did you graduate? YesNo

Special Skills & Qualifications

Previous Employment (begin with most recent position)

POSITION #1
Employed from to

Position(s) held:

Company Name:

Address/City/State/Zip:

Supervisor: Phone:

Title & Responsibilities:

Starting Salary & Title: Ending Salary & Title:

Reason for leaving: May we contact this employer for a reference? YesNo

POSITION #2
Employed from to

Position(s) held:

Company Name:

Address/City/State/Zip:

Supervisor: Phone:

Title & Responsibilities:

Starting Salary & Title: Ending Salary & Title:

Reason for leaving: May we contact this employer for a reference? YesNo

POSITION #3
Employed from to

Position(s) held:

Company Name:

Address/City/State/Zip:

Supervisor: Phone:

Title & Responsibilities:

Starting Salary & Title: Ending Salary & Title:

Reason for leaving: May we contact this employer for a reference? YesNo

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

Express Transmissions, Inc., Transmissions  Automobile, Holland, OH