Chauffer Application

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Personal Information
Name:		Social Security No.:
Address:		City:
State:		Zip:
Phone:
Referred By:

Employment Desired
Position:	Start Date:
Salary Desired:	Are You Employed?:	Yes No
Ever Applied To This Company Before?:

General Information
Subjects of Special Study/Research Work or Special Training/Skills
U.S. Military or Naval Service:		Rank:

Former Employers
Date Month and Year:	to	Salary:
Name & Address of Employer:		Position:
Date Month and Year:	to	Salary:
Name & Address of Employer:		Position:
Date Month and Year:	to	Salary:
Name & Address of Employer:		Position:

References
Name:		Business:
Address:		Years Known:
Name:		Business:
Address:		Years Known:
Name:		Business:
Address:		Years Known:

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 segments 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 of 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.
The waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."

I Agree I Disagree

Chauffer Application

Personal Information

Employment Desired

General Information

Former Employers

References

Authorization

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