Collision Repair Employment

• Name
• Social Security Number
• Email
• Phone
• Address
• City

• State		Zip

• How did you hear about us?

• Military Branch

• Date Entered		Discharge Date

• Rank at Discharge

If discharge is other than honorable please explain:

• Desired Position
• Date Available to Start

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• Are You a Citizen of the United States?

  YES

  NO

• If No, Can You Provide Proof of Work Eligability?

  YES

  NO

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• Have You Worked For Us before?

  YES NO

  If Yes, Please Explain (Include Dates)

• Have You Ever Been Convicted of a Felony?

  YES NO

  If Yes, Please Explain (Include Dates)

• High School

• Did You Graduate?						Major /Subject
  YES			NO

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• College

• Did You Graduate?						Major /Subject
  YES			NO

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• Technical or Trade School

• Did You Graduate?						Major /Subject
  YES			NO

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• Other Education

• Did You Graduate?						Major /Subject
  YES			NO

List any Auto Body Repair Certifications.

• Company Name
• Address / Location
• Phone
• Supervisor Name
• Job Title
• Responsibilities
• Dates Employed

  From:		To:

• Salary / Wages

  Start:		End:

• Reason for Leaving
• May We Contact Employer?

  YES

  NO

• Company Name
• Address / Location
• Phone
• Supervisor Name
• Job Title
• Responsibilities
• Dates Employed

  From:		To:

• Salary / Wages

  Start:		End:

• Reason for Leaving
• May We Contact Employer?

  YES

  NO