Application

Personal Data

Name *

First

Middle

Last

Email *

Phone *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Are you under the age of 18? *

Yes
No

(If hired, verification will be required consistent with federal law)

What is your age? *

Have you ever been convicted of a felony which has not been expunged or sealed by a court? *

Yes
No Record

You should answer “no record” if a conviction has been sealed or expunged or otherwise statutorily eradicated. If you checked yes, please explain below. If more space is required, please use seperate sheet. A criminal conviction will not necessarily be a bar to employment. To help us evaluate your application, please describe the nature of the crime and your subsequent rehabilitation

How were you referred to us? *

Please specify how you were referred to us. *

Employment Availability

Position(s) applied for *

Date you can start *

Wage desired? *

(Please specify per hour or per week.)

Please indicate your availability. *

Full Time
Part Time

How many hours?

Availability

Put the specific hours (From/To) you are available for work in the boxes below. (Leave the box empty if you are not available at all that day and write “A” under any day you are “available” all that day without any scheduling restrictions.)

Sunday (From AM/PM)

Sunday (To AM/PM)

Monday (From AM/PM)

Monday (To AM/PM)

Tuesday (From AM/PM)

Tuesday (To AM/PM)

Wednesday (From AM/PM)

Wednesday (To AM/PM)

Thursday (From AM/PM)

Thursday (To AM/PM)

Friday (From AM/PM)

Friday (To AM/PM)

Saturday (From AM/PM)

Saturday (To AM/PM)

Education

High School Name / GED

High School Address

Address Line 1

Address Line 2

City

State

Zip Code

Highest grade completed.

9th
10th
11th
12th

Graduated from High School

Yes
No

High School Degree / Major

College or University Name

College Address

Address Line 1

Address Line 2

City

State

Zip Code

Highest year of college completed

Freshman
Sophomore
Junior
Senior

Graduated from College

Yes
No

College Degree / Major

Name of Graduate School / Other

Address of Graduate School / Other

Address Line 1

Address Line 2

City

State

Zip Code

Highest Year Completed of Graduate School / Other

1
2
3
4

Graduated from Graduate School / Other

Yes
No

Degree or Major received from Graduate School / Other

Are you currently enrolled in school?

Yes
No

If yes, what is the name and location of the school?

Availability during school vacations?

Full Time
Part Time
None

Other education, training, skills or hobbies relevant to employment consideration.

Employment History

*Beginning with the most recent employment, list the last four employers (including military service) or cover at least a seven year period, whichever is longer. Use seperate sheet if necessary

Current or Most Recent Employer

Most Recent Employer Name

Most Recent Employer Phone

Most Recent Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Most Recent Employer Job Title and Duties

From

To

Most Recent Employer Starting Base Salary or Wage

Most Recent Employer Ending Salary or Wage

Most Recent Employer Supervisor's Name

Most Recent Employer Reason for leaving.

Previous Employer

Previous Employer 1 Name

Previous Employer 1 Phone

Previous Employer 1 Address

Address Line 1

Address Line 2

City

State

Zip Code

Previous Employer 1 Job Title and Duties

Previous Employer 1 Start Date

Previous Employer 1 End Date

Previous Employer 1 Starting Base Salary or Wage

Previous Employer 1 Ending Salary or Wage

Previous Employer 1 Supervisor's Name

Previous Employer 1 reason for leaving.

Previous Employer

Previous Employer 2 Name

Previous Employer 2 Phone

Previous Employer 2 Address

Address Line 1

Address Line 2

City

State

Zip Code

Previous Employer 2 Job Title and Duties

Previous Employer 2 Start Date

Previous Employer 2 End Date

Previous Employer 2 Starting Base Salary or Wage

Previous Employer 2 Ending Salary or Wage

Previous Employer 2 Supervisor's Name

Previous Employer 2 Reason for leaving.

Previous Employer

Previous Employer 3 Name

Previous Employer 3 Phone

Previous Employer 3 Address

Address Line 1

Address Line 2

City

State

Zip Code

Previous Employer 3 Job Title and Duties (copy)

Previous Employer 3 Start Date

Previous Employer 3 End Date

Previous Employer 3 Starting Base Salary or Wage

Previous Employer 3 Ending Salary or Wage

Previous Employer 3 Supervisor's Name

Previous Employer 3 Reason for leaving.

In the past seven years have you ever been discharged, suspended or asked to resign by an employer? *

Yes
No

If yes, give employer name, date of action, and reason

Have you ever worked for us? *

Yes
No

If yes, and not included above, give dates employed, position, any other name used and reason for leaving

May we contact your present employer at this time for a reference? *

Yes
No

For the purpose of verifying information on this application, have you ever worked or attended school under a different name at any of the organizations you have listed? *

Yes
No

If yes, specify name

References

List two professional references familiar with your work ability (exclude relatives)

Reference 1 - Full Name *

First

Last

Reference 1 - Address *

Address Line 1

Address Line 2

City

State

Zip Code

Reference 1 - Phone *

Reference 1 - Occupation *

Reference 1 - How acquainted and for how long?

Reference 2 - Full Name *

First

Last

Reference 2 - Address *

Address Line 1

Address Line 2

City

State

Zip Code

Reference 2 - Phone *

Reference 2 - Occupation *

Reference 2 - How acquainted and for how long?

Read Carefully and Sign

PLEASE READ THESE STATEMENTS OVER CAREFULLY AND INITIAL EACH PARAGRAPH BEFORE SIGNING AT THE BOTTOM

I have disclosed all information that is relevant and should be considered applicable to my candidacy for employment. *

Your Initials

I understand, where permissible under applicable state and local law, I may be subject to a pre-employment drug test after receiving a conditional offer of employment, and must receive a negative result before being permitted to commence work with Harrys-U-Pull It Auto Parts. *

Your Initials

I understand, where permissible under applicable state and local law, I may be subject to a pre-employment medical examination after receiving a conditional offer of employment, and must meet the qualifications for the position, with or without reasonable accommodation, before being permitted to commence work with Harrys-U-Pull It. *

Your Initials

I hereby certify that the information given by me is true in all respects. I authorize Harry's-U-Pull It and its representatives to contact my prior employers and all others for the purpose of verification of the information I have supplied and release same from any liability resulting from the information released. I authorize employers, schools and other persons named on this application to provide any information or transcripts requested. *

Your Initials

I expressly understand and agree that, if employed, my employment, having no specified term, is based upon mutual consent and may be terminated at will, with or without cause, by either party (the employer or me) without prior notice to the other, unless otherwise prohibited by law. *

Your Initials

I understand that no representation, whether oral or written, by any representative or agent of Harrys-U-Pull It, at any time, can constitute an implied or expressed contract of employment. I further understand no representative or agent of Harrys-U-Pull It, has the authority to enter into an agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other terms or condition of employment other than in a document signed by the Director of Human Resources or his/her authorized representative. *

Your Initials

I certify, under penalty of perjury, that all of the above information is true and complete, and I understand that any falsification or omission of information may result in denial of employment or, if hired, may result in termination regardless of the time lapse before discovery. *

Your Initials

MY SIGNATURE IS EVIDENCE THAT I HAVE READ AND AGREE WITH THE ABOVE STATEMENTS

Note: An offer of employment is conditioned upon complying with Harrys-U-Pull It's requirements including, but not limited to signing a Consent to Conduct an Investigation.

Today's Date

Search Inventory

Online Application

Personal Data

Employment Availability

Availability

Education

Employment History

Current or Most Recent Employer

Previous Employer

Previous Employer

Previous Employer

References

Read Carefully and Sign

MY SIGNATURE IS EVIDENCE THAT I HAVE READ AND AGREE WITH THE ABOVE STATEMENTS

Before you go!