Job Application
Harlem Road Automotive
HUMAN RESOURCES                               Office: (815) 654-7171 Fax: (815)654-7189
1501 Harlem Road - Loves Park, IL 61111

EMPLOYMENT APPLICATION
* Harlem Road Automotive is an Equal Opportunity Employer
* Completely fill in this application. Print and fax to (815) 654-7189 or drop off at 1501 Harlem Road, Loves Park, IL 61111.
* Should you have any questions in faxing the form, please call Greg at 654-7171.
* Should you have any questions regarding the contents in the form, please call HR Office at 654-7171.

1. Job
2. Application Date
3. Personal Information
First Name
Middle Name
Last Name
4. Address
Street
City
State
Zip
5. Contact Information
Home Phone
Work Phone
Email
6. Social Security Number
7. Drivers License
Do You Have a Valid Driver's License? Yes No    
Do You Have a Valid Commercial License? Yes No    
8. Have you Ever Worked for Harlem Road Automotive? Yes No    
9. Are you eligible for lawful employment in the United States? If yes, check this box
If hired by Harlem Road Automotive, you will be required to provide proof of identity, and U.S. citizenship of your legal right to work in the United States.
10. Have you served in the armed forces? Yes No    
11. Have you ever resigned from or otherwise left any employment while allegations of misconduct or harrassment on your part were pending or under investigation? Yes No    
12. Are you aware of any current investigation that may possibly result in criminal charges against you? Yes No    
13. Have you ever been discharged or forced to resign from any position? Yes No    
14. Have you used illegal drugs in the last 5 years? Yes No    
15. Have you ever been convicted of any violation of the law, other than minor traffic violations? (e.g. speeding is a minor violation, DUI and reckless driving are not ) Yes No    
16. Are you related to any person employed by the Harlem Road Automotive? Yes No    
17. Professional Certifications, if required (eg. ASE)
Certification Serial No. Date Issued Expiration Date
18. Education
High School Graduate If yes, check this box
College or University
Major Subjects
Date Attended ( e.g. 1/1/2003 )
Check if Graduated
Type of Degree
Graduate School
Major Subjects
Date Attended
Check if Graduated
Type of Degree
Vocational or Special Training
Major Subjects
Date Attended
Check if Graduated
Type of Degree
19. Work Experience
Begin with your present or last position and Military employment and work back. Be specific. If more than one postion was held under the same employer, describe each position separately. Describe your duties in concise detail. Indicate responsibility, supervision, if any, reason for leaving, etc. ( You might attach a resume or other relevant documents to further describe your qualifications.)
Dates of Employment      From To (e.g. 1/23/2000)
Title of Position
Ending Monthly Salary [Numbers Only-No Commas, No Periods]
Name of Employer
Address
Phone
Supervisor
Reason for Leaving
Describe Your Duties
Dates of Employment      From To
Title of Position
Ending Monthly Salary [Numbers Only-No Commas, No Periods]
Name of Employer
Address
Phone
Supervisor
Reason for Leaving
Describe Your Duties
Dates of Employment      From To
Title of Position
Ending Monthly Salary [Numbers Only-No Commas, No Periods]
Name of Employer
Address
Phone
Supervisor
Reason for Leaving
Describe Your Duties
Dates of Employment      From To
Title of Position
Ending Monthly Salary [Numbers Only-No Commas, No Periods]
Name of Employer
Address
Phone
Supervisor
Reason for Leaving
Describe Your Duties
20. May we contact your present employer? Yes No    
Inquiry may be made of your former employers or the last school you attended regarding your performance record.
21. Comments

QUESTIONNAIRE

Harlem Road Automotive is asking all applicants for employment to complete this form in order to comply with United States Government Equal Employment Opportunity requirements. Data collected will be used for statistical purposes and to measure effectiveness of recruitment efforts. This information which you provide voluntarily will be detached from your application and will be kept separate and confidential. Harlem Road Automotive is an equal opportunity employer.
1. Your Birthday
2. Ethnic Origin
White:
Black:
Hispanic:
Asian or Pacific Islander:
American Indian or Alaskan Native:
Other:

 

I authorize Harlem Road Automotive to conduct a background investigation and authorize the release of information in connection with my application for employment. If required for the position, the background investigation may include information released to criminal or civil convictions and motor vehicle reports (driving records) obtained from appropriate sources, including previous employers. I understand that the information will be considered with my qualifications for employment with Harlem Road Automotive.
Harlem Road Automotive obtains Motor Vehicle Reports on employees whose job duties require operation of Company or Customer owned motorized vehicles or equipment. If employed by Harlem Road Automotive, I authorize them to periodically obtain a Motor Vehicle Report. I understand that frequent or repeated traffic violations may affect my employment eligibility with Harlem Road Automotive.
I waive my right of access to such information and hereby release Harlem Road Automotive from any liability in connection with the release or use of the information.
I understand that this employment application and any other Harlem Road Automotive documents are not contracts of employment and that any oral or written statements to the contrary are hereby disavowed by Harlem Road Automotive.


The information I have given on this application for employment is true and complete and is subject to verification by Harlem Road Automotive. I also understand that any misrepresentation or falsification, regardless of when discovered, may subject me to dis-qualification or dismissal from employment with Harlem Road Automotive.

 
 
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