Bennett Auto Supply, Inc.
Employment Application

WELCOME TO BENNETT AUTO SUPPLY, INC.

Thank you for your interest in working at Bennett Auto Supply, Inc. Our programs, services and employment opportunities are available equally to everyone without regard for race, color, religion, national origin, age, sex, veteran status or disability. Please inform the Human Resources Department if you require any reasonable accommodation for the application or interview. Be advised that our acceptance of this application does not create an obligation for us to hire you and that your signature on this application has certain legal consequences. Therefore, we advise you to read the “Applicants Acknowledgement” section at the end of this application before you answer the following questions.

What position are you applying for?_______________________________________

Date of Application:___________________________________________________

Date available to start:________________________________

APPLICANT DATA

Full Name: ____________________________________________________________________
Last, First Middle

Address: _________________________City________________________ State:____ Zip:________

Phone: (_____)_______-___________ Mobile / Beeper: (_____)_______-___________

E-Mail Address:_____________________________________________________

Driver’s Lic. #___________________________________ State:_______________

Social Security #: ____________________________ Salary Desired?:______________________

Type of employment desired (circle): Full-Time, Part-Time, Temporary, Seasonal

What days of the week and hours during the day are you unavailable? Please be specific:

_____________________________________________________________________________

How were you referred to us: ___________________________________________

Have you ever worked for this company (circle one)? YESNO

If yes, when?________________________________________________________

Are you fluent in a language other than English (circle one)? YESNO

If yes, please list the languages you speak read and/or write:_____________________

__________________________________________________________________

Date of birth (if less than 18 years old): _______________

All applicants who are offered employment must provide documents which establish their identity & eligibility for authorization to work in the U.S.

Are you a U.S. citizen? (circle one) YESNO

If no, do you have the legal right to work in the U.S.? (circle one) YESNO

Please explain: __________________________________________________________________

Have you ever been convicted of a crime? (circle one) YESNO
If YES, provide details of the type of crime, the date of conviction and the penalty
imposed:

______________________________________________________________________________

Have you ever been a defendant sued in a civil action for an intentional tort, including assault, battery, slander, libel, false imprisonment or others? If so, please describe the nature of the intentional tort and the outcome of the lawsuit:

_______________________________________________________________________________

Have you ever been accused, disciplined, or fired from any job because of alleged
improper conduct toward another person(circle one)? YESNO
If so, please provide the details of the accusation, discipline, or firing, including the nature of the offense and the outcome:

_______________________________________________________________________________

Have you ever been terminated from a job for which you were entitled to collect unemployment (circle one)? YESNO

If yes, please explain:_______________________________________________________________
Answering yes to this question does not constitute an automatic rejection to employment. Date of offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.

PREVIOUS EMPLOYMENT (begin with your most recent position)

Dates of Employment: From /_____ /_____ To /_____ /_____

Position(s) Held; Last:_________________________ Previous: ___________________________

Company:___________________________ Address:_____________________________________

Phone: (____ )____-______ Supervisor: ________________________ Title: __________________

Responsibilities: __________________________________________________________________

Starting Salary and Title: ________/_________ Ending Salary and Title: _________/_________

Reason for Leaving: _______________________________________________________________

May we contact this employer for references(circle one)? YESNO

Dates of Employment: From /_____ /_____ To /_____ /_____

Position(s) Held; Last:_________________________ Previous: ___________________________

Company:___________________________ Address:_____________________________________

Phone: (____ )____-______ Supervisor: ________________________ Title: __________________

Responsibilities: __________________________________________________________________

Starting Salary and Title: ________/_________ Ending Salary and Title: _________/_________

Reason for Leaving: _______________________________________________________________

May we contact this employer for references(circle one)? YESNO

Dates of Employment: From /_____ /_____ To /_____ /_____

Position(s) Held; Last:_________________________ Previous: ___________________________

Company:___________________________ Address:_____________________________________

Phone: (____ )____-______ Supervisor: ________________________ Title: __________________

Responsibilities: __________________________________________________________________

Starting Salary and Title: ________/_________ Ending Salary and Title: _________/_________

Reason for Leaving: _______________________________________________________________

May we contact this employer for references(circle one)? YESNO

Dates of Employment: From /_____ /_____ To /_____ /_____

Position(s) Held; Last:_________________________ Previous: ___________________________

Company:___________________________ Address:_____________________________________

Phone: (____ )____-______ Supervisor: ________________________ Title: __________________

Responsibilities: __________________________________________________________________

Starting Salary and Title: ________/_________ Ending Salary and Title: _________/_________

Reason for Leaving: _______________________________________________________________

May we contact this employer for references(circle one)? YESNO

EDUCATION

High School:________________________________________________________

Address:___________________________________________________________________

# of Years Completed: __________ Did you graduate(circle one)? YESNO

Major: GPA: Class Rank:___________

College /University:______________________ Address: ______________________________

# of Years Completed: ____________ Did you graduate(circle one)? YESNO

Degree: ___________________________ Major: GPA: Class Rank: ___________

Other: ______________________________ Address: _______________________________

# of Years Completed:_____________ Did you graduate(circle one)? YESNO

Degree: ____________________________ Major: GPA: Class Rank: __________

REFERENCES

Please furnish the names, addresses and telephone numbers of two people to whom you are not related and bi’ whom you have not been employed:

Name: ____________________ Relationship: _________ Phone: (_____ )______-________

Address: _______________________ City: ________________ State: ____ Zip: _________

Name: ____________________ Relationship: _________ Phone: (_____ )______-________

Address: _______________________ City: ________________ State: ____ Zip: _________

Name: ____________________ Relationship: _________ Phone: (_____ )______-________

Address: _______________________ City: ________________ State: ____ Zip: _________

Summarize your special skills or qualifications: ______________________________________

_________________________________________________________________________

DRIVER’S LICENSE & ENDORSEMENTS (for the past seven years)

Operation Licenses:__________________________________________________________

Operating Permits:___________________________________________________________

Certifications:_______________________________________________________________

DRIVING EXPERIENCE

Class of Equipment: __________________________________________________________

Types of Equipment Used: _____________________________________________________

Types of Commodities Transported: ______________________________________________

Years of Experience: ___________

APPLICANT’S ACKNOWLEDGEMENT:

It is very important that you read the following section carefully, and that you fully understand it before you sign your name. This section affects your legal rights. If you have any questions regarding those legal rights, please ask them before you sign this application. If you do not ask, we will assume that you fully understand the language set forth below. In exchange for Bennett Auto Supply, Inc. considering this employment application

1. I certify that my answers are true and complete to the best of my knowledge. I authorize you, your agents or assigns to make such investigations and inquiries of my personal, employment, educational, financial, or medical history and other related matters as may be necessary for an employment decision. Further, I agree to hold Bennett Auto Supply, Inc., its agents or assigns harmless for disclosure and authorize them to release any and all information pertaining to me and my employment.

2. I understand that Bennett Auto Supply, Inc. maintains a full and/or modified drug free workplace and that a policy is available for review upon request. I may be required to submit to a drug/alcohol test, under-go a post-job offer medical examination, or pencil and paper tests, designed to determine my suitability for the job for which I am being considered. Additionally, from time to time, I may be required to take subsequent tests during the course of my employment and consent to such post-job offer and post-hire testing. I understand that, subject to applicable laws, Bennett Auto Supply, Inc. shall be the sole judge of the acceptability of any test results.

3. I understand that any misstated, misleading, incomplete, or false information in this application is grounds for rejection of this application, refusal to hire, a withdrawal of an offer of employment, or immediate discharge without recourse, whenever and however discovered.

4. I fully understand and acknowledge, and where applicable consent to, the following:

• That my employment is at will;
• That I may be discharged for any reason, without notice;
• That I am subject to a 90-day introductory period;
• That Bennett Auto Supply, Inc. may conduct a criminal background, a driver’s license and credit investigation and will check my references;
• That work schedules may vary and can be unpredictable, and that as such I may be required to work a different shift, weekends, or over time;
• That I will be required to comply with the policies and protocols set forth in the employee handbook of Bennett Auto Supply, Inc. or in other printed documents.
• That Bennett Auto Supply, Inc. reserves the right to am