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Employment Application
Programs, services and employment are equally available to everyone. Please inform the Human Resources Department if you require reasonable accommodation for the application or interview.
Application Information
Date of application
Contact Information
Full name
Address
City
• State
• Zip
Phone
• Cell/Pager/Other
Email
Personal Information
Social security number
Driver's license number
• State
If you are under 18 years of age, can you provide a work permit? • Yes
• No
If no, please explain
Are you a citizen of the United States? • Yes
• No
If not, are you legally allowed to work in the United States? • Yes
• No
Criminal Record
Have you ever pleaded guilty, no contest or been convicted of a crime? • Yes
• No
If yes, give dates and details
Answering yes to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.
Position Desired Information
Position applied for
Date available to start
Salary Requirements
How were you referred to us?
Have you every worked for this company? • Yes
• No
If yes, when?
Type of employment desired? • Full-time
• Part-time
• Temporary
• Seasonal
Summarize Your Special Skills or Qualifications
Previous Employment (most recent position)
Dates of employment from
to
Positions held
Company name
Address
City
• State
• Zip
Phone
Supervisor's name
• Supervisor's title
Responsibilities
Starting annual salary
• Starting title
Final annual salary
• Final title
Reason for leaving
May we contact this employer for a reference? • Yes
• No
Previous Employment (2nd most recent position)
Dates of employment from
to
Positions held
Company name
Address
City
• State
• Zip
Phone
Supervisor's name
• Supervisor's title
Responsibilities
Starting annual salary
• Starting title
Final annual salary
• Final title
Reason for leaving
May we contact this employer for a reference? • Yes
• No
Previous Employment (3rd most recent position)
Dates of employment from
to
Positions held
Company name
Address
City
• State
• Zip
Phone
Supervisor's name
• Supervisor's title
Responsibilities
Starting annual salary
• Starting title
Final annual salary
• Final title
Reason for leaving
May we contact this employer for a reference? • Yes
• No
I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial and other related matters as may be necessary for an employment decision. I hereby release employers, schools or individuals from all liability when responding to inquiries in connection with my application.
In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.
web:
www.FCMuffler.com
phone: (970) 484-0866
fax: (970) 407-7829
email:
info@FCMuffler.com
2003 South College Avenue Fort Collins, CO 80525
