Employment Application - ASAP Car Parts

Applicant Information
Date
Date Format: MM slash DD slash YYYY
First Name*
Middle Initial
Last Name*
Street Address*
Apartment/Unit #
City*
State*
Zip*
Cell Phone*
Home Phone
Email*
Enter Email Confirm Email
Socail Security Number*
Are you a citizen of the United States?*
- Yes
- No
If no, are you authorized to work in the U.S.?*
- Yes
- No
Have you ever worked for this company?*
- Yes
- No
If yes, when?*
Date Format: MM slash DD slash YYYY
Have you ever been convicted of a felony?*
- Yes
- No
If yes, explain:*
Upload your Cover Letter / Resume
Drop files here or
Education
High School
Address
From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
Did you graduate?
- Yes
- No
Diploma
Education cont.
College
Address
From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
Did you graduate?
- Yes
- No
Degree
Education cont.
Other
Address
From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
Did you graduate?
- Yes
- No
Degree
Availability
Position Applied For:*
Desired Salary*
Date Available*
Date Format: MM slash DD slash YYYY
Number of hours desired*
*
- Full Time
- Part Time
- Full or Part Time
Can you work night or weekends?*
- Yes
- No
Monday
Earliest Time*
Latest Time*
Tuesday
Earliest Time*
Latest Time*
Wednesday
Earliest Time*
Latest Time*
Thursday
Earliest Time*
Latest Time*
Friday
Earliest Time*
Latest Time*
Saturday
Earliest Time*
Latest Time*
Sunday
Earliest Time*
Latest Time*
References
Full Name
Relationship
Company
Phone
Address
References cont.
Full Name
Relationship
Company
Phone
Address
References cont.
Full Name
Relationship
Company
Phone
Address
Previous Employment
Company*
Phone
Address
Supervisor
Job Title*
Starting Salary*
Ending Salary*
Responsibilities
From*
Date Format: MM slash DD slash YYYY
To*
Date Format: MM slash DD slash YYYY
Reason for Leaving*
May we contact your previous supervisor for a reference?*
- Yes
- No
Previous Employment cont.
Company
Phone
Address
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
Reason for Leaving
May we contact your previous supervisor for a reference?
- Yes
- No
Previous Employment cont.
Company
Phone
Address
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
Reason for Leaving
May we contact your previous supervisor for a reference?
- Yes
- No
Previous Employment cont.
Company
Phone
Address
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
Reason for Leaving
May we contact your previous supervisor for a reference?
- Yes
- No
Military Service
Branch
From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
Rank at Discharge
Type of Discharge
If other than honorable, explain
Disclaimer and Signature
Please read the following statement and acknowledgement carefully before signing this application: I verify that the information provided on this application is true, complete and accurate. I agree that ASAP Car Parts, Inc. (“ASAP”) may investigate all of the statements made on this application and that any misrepresentation or omission in my application, resume, any other employment-related materials, or during any interview may result in ASAP refusal to employ me, or if employed, may result in immediate termination of my employment.

I understand that any offer of employment I may receive from ASAP, Inc. is conditioned on my successful completion of the Company’s pre-employment screening process, including without limitation, drug testing and background, criminal records, employment history, and reference checks. I understand that my continued at-will employment may be conditioned on successful completion of subsequent background and criminal records checks and drug testing conducted during my employment in accordance with Company policy and applicable law.

I agree to comply with all of ASAP policies, rules and procedures in effect during my employment and understand that my employment will remain at-will. I understand that no employee, manager or other agent of ASAP has any authority to enter into any agreement for employment for any specified period of time unless such agreement is in writing and signed by the Member of the Company. I further understand that in the absence of such an agreement, employment can be terminated with or without cause by the Company or me at any time.
Signature*
Date*
Date Format: MM slash DD slash YYYY
Drug Screening Consent and Authorization
The Company strives to maintain a work environment that is safe and conducive to high work standards for its employees and others having business with the Company. As part of these commitments, the Company has adopted a drug-free workplace policy. Our goal will continue to be one of establishing a work environment that is free from the effects of substance abuse.

Pursuant to these goals, the Company requires that you, if you are a final, external applicant for the position for which you are applying, submit to a drug screening to be conducted in accordance with applicable law. Your employment is conditioned upon successful completion of the drug screen.

During your employment, you may be required to undergo additional drug screenings in accordance with applicable law and the Company’s policy. The drug screen will be conducted by an authorized testing facility and you must authorize the release of the test results to the Company. These results will be used solely in connection with your employment with the Company and will be kept confidential. Refusal to sign this authorization or to submit to the drug screening will render you ineligible for further employment consideration.

Further, upon selection for employment by the Company, you hereby agree to comply with all terms of the Company’s Drug-Free Workplace Policy (the “Policy”), specifically the following: I will read the Policy which is available to me upon request. I agree to submit to drug testing according to the Company’s Policy. I understand that failure to comply with a drug testing request will lead to termination of employment. I understand that the Policy may be amended at the Company’s discretion. I hereby release the Company, its officers, employees, and agents from any and all liability whatsoever as a result of taking drug tests and the transmitting and utilization of the results and opinions thereof.

I, the undersigned, have read and understand this document and hereby authorize the release of the results of any drug screen I undergo to the Company for the above-stated purposes.
Signature*
Date*
Date Format: MM slash DD slash YYYY
Consumer Authorization
1. In processing my application for employment and if employed, in connection with my continued at-will employment, I understand that ASAP Car Parts, Inc. (“ASAP”) may obtain or have prepared a consumer or investigative consumer report for employment purposes. I understand that any such report may include information concerning my criminal records history, prior employment, driving record, civil litigation, military record, education, professional licenses or credentials, credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, mode of living, and work habits. I understand that any of the foregoing categories of information may be used by ASAP as a basis for rejecting my application, considering my status for continued employment, or terminating my employment.
2. By signing below (either manually or electronically), I acknowledge and understand that I have received notice in compliance with the Fair Credit Reporting Act (“FCRA”) that ASAP may seek a consumer or investigative consumer report as outlined in paragraph I above. I am authorizing ASAP to obtain a consumer or investigative consumer report on me as part of the Company’s pre-employment background screening process. If I am offered employment by ASAP, I further authorize the Company to obtain additional consumer or investigative consumer reports on me for employment purposes at any time during my employment.
3. I further authorize ASAP to release to any consumer reporting agency or investigators the personal information on this form, my application or any other information ASAP may require me to complete for the purpose of conducting any background check.
4. I understand that that I am entitled to request that ASAP inform me as to whether an investigative consumer report (or reports) is being obtained or prepared. I am further entitled to request from ASAP information on the scope and nature of the investigation underlying any investigative consumer report and to obtain a written summary of my rights under the FCRA. If ASAP wishes to take an adverse action against me based on information in either the consumer report or the investigative consumer report, I am entitled to receive a copy of the report with a description of my rights under the FCRA. Finally, I understand that if ASAP takes an adverse action against me, ASAP must provide me with the name, address, and telephone number of the agency, and I am further entitled to request a free copy of the report from the agency within sixty days.
5. I hereby direct each consumer reporting agency and/or investigative consumer reporting agency to release information concerning me contained in a consumer or investigative consumer report upon request to ASAP. This release is executed with my full knowledge and understanding that the information is for the official and employment-related use by ASAP as provided above.
6. I hereby agree not to assert claims against ASAP or any consumer reporting agency(s), including any of their officers, agents, employees or related personnel, for any and all liabilities or damages of whatever kind, which may at any time result to me because of compliance with or release of information pursuant to this authorization.
7. I acknowledge that a facsimile, photographic or other electronic copy of this release and authorization shall be as valid as the original, and I agree that the authorization can be relied upon by ASAP and its agents. I represent that I have read and understand this authorization.
First Name*
Middle Initial
Last Name*
Birthdate*
Date Format: MM slash DD slash YYYY
Have you ever gone by a different name?*
- Yes
- No
Please list your other name you have gone by to the right.
First Name*
Middle Initial
Last Name*
Street Address*
Apartment/Unit #
City*
State*
Zip*
Social Security Number*
Driver's License Number*
Driver's License State*
Signature*
Date*
Date Format: MM slash DD slash YYYY
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Employment

Applicant Information

Education

Education cont.

Education cont.

Availability

References

References cont.

References cont.

Previous Employment

Previous Employment cont.

Previous Employment cont.

Previous Employment cont.

Military Service

Disclaimer and Signature

Drug Screening Consent and Authorization

Consumer Authorization