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EMPLOYMENT APPLICATION
PERSONAL INFORMATION
First Name
(Required)
Middle Name
Last Name
(Required)
Date
MM slash DD slash YYYY
Social Security Number
Present Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email
(Required)
Phone Number
(Required)
Are you 18 years or older?
Yes
No
Are you prevented from lawfully becoming employed in this country because of Visa or immigration status?
Yes
No
Have you ever been convicted of a crime?
Yes
No
Do you possess a valid driver's license?
Yes
No
Do you possess a valid CDL?
Yes
No
This section to be completed by ALL applicants:
Drivers License Number & State of Issuance
Date of Birth
MM slash DD slash YYYY
EMPLOYMENT DESIRED
Position
(Required)
Accounts Payable Clerk
Accounts Receivable Clerk
Administrative Assistant
Body Shop - Body Technician
Body Shop - Detailer
Body Shop - Painter
Diesel Technician
Diesel Technician - Entry Level
Diesel Technician - Mobile Maintenance
Fleet Technician
General Manager/Branch Manager
Lease Sales Representative
Parts Counterperson
Parts Driver - Non CDL
Parts Driver - CDL
Parts Manager
Parts Outside Sales Representative
Parts Warehouse Clerk
Rental Coordinator
Service Advisor
Service Driver - CDL
Service Foreman
Service Manager
Shipping & Receiving Clerk
Trainer - Commercial Truck/Diesel Engine
Truck Sales Representative
Other
Other Position (not listed)
Date you can start
MM slash DD slash YYYY
Salary Desired
Shift Preference
If applying for a service technician position, do you have your own tools?
Yes
No
Are you employed now?
Yes
No
If yes, with whom?
If so, may we inquire of your present employer?
Ever applied to this company before?
Yes
No
Where?
When?
EDUCATION
Grammar School
Name and Location of School
No. of Years Attended
Did you Graduate?
Subjects Studied
Add
Remove
High School
Name and Location of School
No. of Years Attended
Did you Graduate?
Subjects Studied
Add
Remove
College
Name and Location of School
No. of Years Attended
Did you Graduate?
Subjects Studied
Add
Remove
Trade or Business School
Name and Location of School
No. of Years Attended
Did you Graduate?
Subjects Studied
Add
Remove
GENERAL
Describe any specialized training, apprenticeships, certifications, licenses, or skills:
Have you received any job-related training in the United States Military or Naval Academy?
Yes
No
If so, please provide dates and describe
FORMER EMPLOYERS (LIST BELOW LAST FOUR EMPLOYERS, STARTING WITH LAST ONE FIRST)
From - To
Date (Month and Year)
Name and City of Employer
Salary
Position
Reason for Leaving
Add
Remove
Explain any periods of unemployment between positions:
Which of these jobs did you like best and why?
FORMER SUPERVISORS
LIST THE SUPERVISORS YOU WORKED FOR AT THE JOBS ABOVE
Name
Business
Telephone
Add
Remove
In case of emergency notify:
Telephone
Address
I certify that all of the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated. In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than it's president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.
Signature
(Required)
Date
MM slash DD slash YYYY
AUTHORIZATION AND RELEASE
In consideration of the agreement by UpfitWorks to receive and consider my application for employment, I hereby authorize, consent and grant the privilege to UpfitWorks and its agents to review and examine any public or private records pertaining to my educational, personal and credit history, driver's license verification & driving history, and criminal conviction history. I expressly release UpfitWorks and its agents from liability whatsoever arising out of such investigation. All information will be kept confidential by UpfitWorks and is used only by the Human Resources Department.
Have you used any other name than the one provided above?
(Required)
Yes
No
If yes, list other names and dates of use:
Previous Address (if lived in above address for less than 7 years)
By signing below, I agree to the above authorization and release statement.
Date
MM slash DD slash YYYY
NOTE: THIS FORM GOES DIRECTLY TO HUMAN RESOURCES
SELF IDENTIFICATION FORM
UpfitWorks has adopted an Affirmative Action Ordnance and the following information is voluntary and allows us to meet government-reporting requirements and evaluate the effectiveness of our recruitment efforts. The information will be kept confidential and when reported, data will not identify any specific individual. Refusal to provide this information will not subject you to any adverse treatment in accordance with any of UpfitWorks' policies and ordinances, which forbids discrimination-based on this information.
VETERAN STATUS: (Please check one)
Non Veteran
Veteran (DD214 From must be attached)
Veteran claiming disability (DD214 Form and Veterans Disability Form must be attached)
Other (specify service dates)
Other:
ETHNICITY: (SELECT ONE)
Hispanic or Latino (Person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race)
Not Hispanic or Latino
RACE: (SELECT ONE OR MORE)
American Indian or Alaskan Native — A Person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.
Asian —A Person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
Black or African American — A Person having origins in any of the Black racial groups of North Africa.
Native Hawaiian or Other Pacific Islander — A Person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
White — Person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
GENDER:
Male
Female
DATE OF BIRTH:
MM slash DD slash YYYY
SOCIAL SECURITY NUMBER:
If you should become a finalist in the hiring process, UpfitWorks will require your date of birth. This information is intended for the sole use of a background investigation process for candidates. The provision of your social security number is not mandatory. It will be used only for applicant tracking purposes. If you choose not to provide your SS# at this time, the Human Resources Department will provide you an arbitrary nine-digit number.
DISABILITY: Do you have a disability?
Yes
No
Upfitworks considers a person with a disability anyone who meets the definition under either the American With Disabilities Act or the Wisconsin Fair Employment Act. You may contact the Occupational Accommodations Specialist at the number listed below if you need additional information. If you need reasonable accommodation(s) during the application process due to disability related functional limitations, please notify UpfitWorks Human Resource Department.
I need an accommodation in the hiring/ examination process:
Yes
No
If yes, accommodation requested is (i.e., extended time, reader, alternative test format, other):
**You will be required to provide written verification from a doctor or other authorized person confirming your disability and indicating reasonable accommodation.
How did you learn of this position? Please choose all that apply
(Required)
UpfitWorks website
Referral (Employee, Friend, Family)
Facebook or Other Social Media
Online/Internet Ad
Indeed
Zip Recruiter
Other Job Board
Recruiter
Referred by:
Other:
