employment Personal Information Name* Desired Salary* Available Start Date* *Note: A valid Social Security number and Driver's License must be provided upon being offered a position at Femal's Auto Body. Are you a citizen of the United States?* YesNo If no, are you authorized to work in the United States?* YesNo Have you previously been employed with Femal's Auto Body?* YesNo If yes, when? Have you ever been convicted of a felony?* YesNo If yes, what? Education History High School Did You Graduate?* YesNo College Trade, Business or Correspondence School Did You Graduate? YesNo References Please list three (3) employment or personal references. Do not list relatives. Reference 1* Reference 2* Reference 3* Employment History Employer* Address* Phone Number* Supervisor* Job Title* Type of Position* Full-timePart-timeSeasonalTemporary Time Employed* Hourly Rate or Salary* May we contact this employer for reference?* YesNo Employment History Continued Employer Address Phone Number Supervisor Job Title Type of Position Full-timePart-timeSeasonalTemporary Time Employed Hourly Rate or Salary May we contact this employer for reference? YesNo Military Service From what time? If other than honorable, explain: Certification 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 statements contained herein and the references and employers listed above to give you any and all information concerning my pervious employment and any pertinent information they may have, personal or 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. This waiver does not permit the release or use of disability related or medical information in a manner prohibited by the Americans of Disabilities Act (ADA) and other relevant federal and state laws.” I understand and agree to the above disclosure statement * By typing my name, I am electronically signing my application.