Performance Truck Center
Employment Application Form

Applicants May Be Tested for Illegal Drugs

Date

Name
Address

How Long
Telephone
Age (if under 18)
Position Applied For
Desired Salary

Days Available to work
No Pref YesNo | Thur YesNo
Mon YesNo | Fri YesNo
Tues YesNo | Sat YesNo
Wed YesNo | Sun YesNo

How many hours can you work
Can you work nights? YesNo
Employment Desired: Full-Time OnlyPart-Time OnlyFull- or Part-Time

Education

Name Location Years Completed Major & Degree
High School
College
Business or Trade School
Professional School

Have you ever been convicted of a crime? YesNo
If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation

Do you have a driver's license? YesNo
OperatorCommercial (CDL)Chauffeur
What is your means of transportation to work?
Driver's license number
Expiration Date
State of Issue

Have you had any accidents during the past three years? YesNo
How many?
Have you had any moving violations during the past three years? YesNo
How many?

Typing: YesNo WPM
10-key YesNo
Word Processing: YesNo WPM
Personal Computer YesNo
PCMac
Other Skills

References

Reference 1

Name
Position
Company
Address


Telephone

Reference 2

Name
Position
Company
Address


Telephone

An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.

Have you ever been in the armed forces? YesNo
Are you now a member of the national guard? YesNo
Specialty
Date Entered Discharge Date

Employment History

Please list your work experience for the past five years beginning with your most recent job held. If you were self employed, give firm name.

Job 1

Name of employer
Address


Phone Number
Name of Last Supervisor
Employement Dates
From To
Pay or Salary
Start Final
Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Job 2

Name of employer
Address


Phone Number
Name of Last Supervisor
Employement Dates
From To
Pay or Salary
Start Final
Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Job 3

Name of employer
Address


Phone Number
Name of Last Supervisor
Employement Dates
From To
Pay or Salary
Start Final
Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Job 4

Name of employer
Address


Phone Number
Name of Last Supervisor
Employement Dates
From To
Pay or Salary
Start Final
Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Job 5

Name of employer
Address


Phone Number
Name of Last Supervisor
Employement Dates
From To
Pay or Salary
Start Final
Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Job 6

Name of employer
Address


Phone Number
Name of Last Supervisor
Employement Dates
From To
Pay or Salary
Start Final
Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

May we contact your present employer? YesNo
Did you complete this application yourself? YesNo
If not, who did?

APPLICATION FORM WAIVER

In exchange for the consideration of my job application by Performance Trucks (hereinafter called "the Company") I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefits plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Performance Trucks, or otherwise to change in any respect the employement-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President/General Manager of the Company. Both te undersigned and Performance Trucks may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at eny time without previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract.

I also understand that (1) the Company has a drug and alcohol policy that provides for preemployment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations.

I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.

I further understand that my employment with the Company shall be probationary for a period of sixty (60) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.

Applicant Name Date

This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.

Thank you for completing this application for and for your interest in our business.