Gobel's Towing - Job Application

1860 E South Range Rd.,

North Lima, OH 44452

Phone: (330) 549-3562

1-888-827-9259

Job Application

Date *

Personal Information

Email Type

Email *

Name Prefix

Last Name *

First Name *

Present Address

Address Country

Present Address *

Present Address

Address City *

Address State

Address Zip Code *

Permanent Address

Address Country 1

Permanent Address *

Permanent Address

Permanent Address City *

Permanent Address State

Permanent Address Zip Code *

Phone No.

Phone Country

Phone Number *

Phone Extension

Secondary Phone No.

Phone Country 1

Phone Number 1 *

Phone Extension 1

Referred By

Empoyment Desired

Position *

Date you can start *

Salary Desired

Are you employed now? *

If so, may we Inquire of your present employer?

Are you legally authorized to work in the U.S.?

Ever applied to this company before? *

Where you Applied?

When you Applied?

Ever worked for this company before? *

Where you worked?

When You worked?

Reason for leaving?

Name of last supervisor at this company?

How did you find out about this position? *

Other please explain

Education History

High School
Name & Location
Years Attenended
Did you graduate
Subjects Studied *

College
Name & Location
Years Attenended
Did you graduate
Subjects

Trade, Business. or Correspondence School
Name & Location
Years Attenended
Did you graduate
Subjects

General Information

Subject of special study / research work

Special Training, certifications, licenses

Special Skills, foreign languages, etc

Military Service Record

Have you ever served in the U. S. Armed forces? *

Branch of Service

Discharge date

Rank

Application for Employment

Former Employers (List below last three employers, starting with the most recent)

Name of present or last employer *

Present or last employer address

Address Country 2

Present or last employer Address *

Address 2

Present of last employer City *

Present of last employer State

Present of last employerZip Code *

Starting Date present / last employer

Leaving date present / last employer

Job Title present / last employer

Weekly Starting Salary present / last employer

Weekly Final Salary present / last employer

May we contact your supervisor?

Name of Supervisor present / last employer

Title of present / last employer

Phone present / last employer

Description of work present / last employer

Reason for leaving present / last employer

Name of prefious employer 2

Name of previous employer 2

Address Country 3

Name of previous employer address 2 *

Address 2

Name of previous employer 2 City *

Name of previous employer 2 State

Name of previous employer 2 Zip Code *

Previous employer 2 starting date

Previous employer 2 leaving date

Previous employer 2 job title

Previous employer 2 weekly starting salary

Previous employer 2 weekly final salary

May we contact your previous employer 2

Name of employer 2 supervisor

Name of employer 2 supervisor's title

Employer 2 phone

Description of work at employer 2

Reason for leaving employer 2

References (List professional references whom we may contact)

Name of Reference 1
Address
Business
Phone

Name of Reference 2
Address
Business
Phone

Name of Reference 3
Address
Business
Phone

Special Purpose Questions

Do not answer ANY of the questions in this box unless the employer has checked the box preceding a question, thereby indication that the information is required for a bona fide occupational qualification, or dictated by national security laws, or is needed for other legally permissible reasons.

Height in feet and Inches

Weight in Lbs.

Are you a U.S. Citizen? *

Have you ever been convicted of a felony or misdemeanor

Felony

Misdemeanor in the last 5 years

Not Convicted of any crime

Describe Felony and/or Misdemeanor

You will not be denied employment solely because of a conviction record, unlessthe offense is related to the job for which you have applied.

Testing *

I understand and gree that I may be required to take one or more

Physical Exam

Drug Test

Lie Detector Test, as a condition of hiring or contunued employment.

I agree to consent to take such test(s) at such time as
designated by the Company and to release the
Company. its directors, officers, agents or employees
from any claim arising in commection with te use of
such test(s). *

Yes

No

I have been advised that lie detector tests, as a condtion
of hiring or continued employment, are prohibited by law. *

Yes

No

Are you able to perform each of the following job function with or without an accomodation?

Job Function #1 *

Yes

No

Job Function #1: If you can perform the funtion with an accommodation,
explain how you would perform the tasks, and with what accomodation?

Job Function #2 *

Yes

No

Job Function #2: If you can perform the funtion with an accommodation,
explain how you would perform the tasks, and with what accomodation?

Job Function #3 *

Yes

No

Job Function #3: If you can perform the funtion with an accommodation,
explain how you would perform the tasks, and with what accomodation?

Were you ever seriously injured? *

Yes

No

Give Details of Serious Injury.

What foreign languages do you speak fluently?

What foreign languages do you write fluently?

What foreign languages do you read fluently?

Authorization

"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 contained 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 American with Disabilities Act (ADA) and other relevant federal and state laws.”

Date application is signed

Signature

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© 2016 Gobel's Towing

1860 E South Range Rd., North Lima, OH 44452
Phone: (330) 549-3562 or 1-888-827-9259