Application Form 

Contact Info

E-Mail address:

Last Name:

First Name:

Middle Initial:

Home Address:

Address:

City:

State:

Zip Code:

Home Phone Number:

Pager Number:

Cellular Number:

Work Number:

Details

Geographical area you are interested in:

How did you hear about AutoStaffNow:

Position(s) Desired (select all that pertain):
(To select more than one: PC Users - hold in the ctrl key and click with the mouse. Macintosh Users - hold in the command key and click with the mouse.)

Preferred Monthly Income:

Your Income Last Year:

Are there any limitations on the hours you will work?

Please explain:

Are you a High School graduate? (includes GED)

Did you attend a Jr. College, Community College,
Vocational or Trade School:

Did you complete the program:

Name of Program:

Are you a College Graduate:

What College or University:

What Degree:

What other education, training, seminars etc. do you have? Give Details.

Computer Experience:

Administrator
Literate
Average
Novice
None

Types of Computer Systems (select all that pertain):
(To select more than one: PC Users - hold in the ctrl key and click with the mouse. Macintosh Users - hold in the command key and click with the mouse.)

Do you have PC experience:

Do you have a valid drivers license:

Have you had a DUI within the past 5 years:

Do you have any moving violations over the past 5 years:

If yes, explain:

Do you smoke:

Do you object to drug testing:

Do you object to aptitude or skills testing:

Do you have any trips or vacations planned in the near future:

If yes - Dates/explain:

Do you have a current resume:

Will you:

Fax:
E-mail:
Mail:
Hand Deliver to us:

Employment History

We need at least 8 years of prior employment - no gaps. Please give lots of details!

1. Current or Last Employer

Employer:

Position(s) Held:

Dates Employed: From:

To:

Duties:

Accomplishments:

Monthly Income:

Reasons for leaving or wanting to leave:

Supervisor / Reference:

May we contact this employer:

2. Prior Employer

Employer:

Position(s) Held:

Dates Employed: From:

To:

Duties:

Accomplishments:

Monthly Income:

Reasons for leaving:

Supervisor / Reference:

May we contact this employer:

3. Prior Employer

Employer:

Position(s) Held:

Dates Employed: From:

To:

Duties:

Accomplishments:

Monthly Income:

Reasons for leaving:

Supervisor / Reference:

May we contact this employer:

4. Prior Employer

Employer:

Position(s) Held:

Dates Employed: From:

To:

Duties:

Accomplishments:

Monthly Income:

Reasons for leaving:

Supervisor / Reference:

May we contact this employer:

5. Prior Employer

Employer:

Position(s) Held:

Dates Employed: From:

To:

Duties:

Accomplishments:

Monthly Income:

Reasons for leaving:

Supervisor / Reference:

May we contact this employer:

Professional References

People we can call now that can professionally comment on your skills and ability.

Name:

How Known:

Phone Number:

Name:

How Known:

Phone Number:

Name:

How Known:

Phone Number:

Additional Comments: Please let us know:

1. What you are looking for in a new employer.
2. What you are not looking for.
3. Employers/Individuals you will not work for.
4. Employers/Individuals you have already talked to.