Employment Application
2360 Boswell Rd
.
An Equal Opportunity Employer
Chula Vista, CA. 91914
(800) 776-0767
(619) 216-1444
FX: (619) 216-1474
www.explorerprocomp.com
Date: ___________________
Please Print
Name _________________________________________________________________________________
Last
First
Middle
Present Address ________________________________________________________________________
No.
Street
City
State
Zip
Permanent Address
If different from present address
____________________________________________________________________________________________
No.
Street
City
State
Zip
Home Telephone (
)
Business Telephone (
)
Social Security No.
-
-
Employment Position Desired
Position applying for: _____________________________________________________________________
Are you applying for:
Full-time
Part-time
Temporary
What days and hours are you available for work? _______________________________________________
If applying for temporary work, during what period of time will you be available? From ____ To _____
Are you available for work on weekends? Yes ____
No ____
If hired, on what date can you start work?
Salary desired: ___________
Personal Information
Have you ever applied to or worked for Pro Comp Suspension? Yes _____ No _____ If yes, when? _______
Do you have any friends or relatives working for Pro Comp Suspension? Yes _____ No _____
If yes, state name(s) and relationship __________________________________________________________
Why are you applying for work at Pro Comp Suspension? _________________________________________
If hired, would you have a reliable means of transportation to and from work? Yes _____ No _____
Are you at least 18 years old? Yes ____ No ____
(if under 18, hire is subject to certification that you are of minimum legal age.)
If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this
country? Yes _____ No _____
Are you able to perform the essential functions of the job for which you are applying? Yes _____ No ____
(If no, describe the functions that cannot be performed)
(Note: We comply with the ADA and consider reasonable accommodation measures that may necessary for eligible applicants/employees to
perform essential functions. Hire may be subject to passing a medical examination, and or skill and eligibility tests.)
Have you ever been convicted of a criminal offense (felony or serious misdemeanor)? (Convictions for
marijuana-related offenses that are more then two years old need not be listed.) Yes _____ No _____ if yes,
state nature of the crime(s), when and where convicted and disposition of the case.
(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, the data of the
offense, the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)
Are you currently employed? Yes ___ No ___ If so, may we contact your current employer? Yes ___ No __
HR Employment Application
Revised 5/05
Page 2
Education, Training and Experience
School
Name and Address
No. Of Years
Did you
Degree or
Completed
Graduate?
Diploma
High School ___________________________________________ Yes ____ No ____ ______________
College/University ______________________________________ Yes ____ No ____
______________
Vocational/Business _____________________________________Yes ____ No ____
______________
Many of our customers do not speak English. Do you write or understand any foreign languages?
Yes ____ No ____ If yes, which language(s)
______________________________________________________________________________________
Do you have any other experience, training, qualifications or skills, which you feel make you especially suited
for work at Pro Comp Suspension? If so, please explain
______________________________________________________________________________________
Are you licensed/certified for the job applied for? Yes ____ No ____ If so Issuing State _______________
Name of license/certification _______________________ License/Certification number _______________
Has your license/certification ever been revoked or suspended Yes ____ No ____ If yes, state reason(s), date
of revocation or suspension and date of reinstatement.
______________________________________________________________________________________
Employment History
List below all present and past employment starting with your most recent employer (last 10 years is
sufficient). Account for all periods of unemployment.
You must complete this section even if attaching resume.
Name of Employer ______________________________________________________________________
Address________________________________________________________________________________
No.
Street
City
State
Zip
Type of Business ________________________________________________________________________
Telephone No. (
)
Your Supervisor's Name _______________________
Your Position and Duties __________________________________________________________________
Date of Employment: From _________ To _________ Weekly Pay: Starting __________ Ending ________
Nick Name (known by) ___________________________________________________________________
Reason for Leaving: ______________________________________________________________________
Name of Employer ______________________________________________________________________
Address________________________________________________________________________________
No.
Street
City
State
Zip
Type of Business ________________________________________________________________________
Telephone No. (
)
Your Supervisor's Name _______________________
Your Position and Duties _________________________________________________________________
Date of Employment: From _________ To __________ Weekly Pay: Starting __________ Ending _______
Nick Name (known by) ___________________________________________________________________
Reason for Leaving: ______________________________________________________________________
Name of Employer ______________________________________________________________________
Address________________________________________________________________________________
No.
Street
City
State
Zip
Type of Business ________________________________________________________________________
Telephone No. (
)
Your Supervisor's Name _______________________
Your Position and Duties _________________________________________________________________
Date of Employment: From _________ To __________ Weekly Pay: Starting __________ Ending _______
Nick Name (known by) ___________________________________________________________________
Reason for Leaving: ______________________________________________________________________
Page 3
Employment History (continued)
Name of Employer ______________________________________________________________________
Address________________________________________________________________________________
No.
Street
City
State
Zip
Type of Business ________________________________________________________________________
Telephone No. (
)
Your Supervisor's Name _______________________
Your Position and Duties _________________________________________________________________
Date of Employment: From _________ To __________ Weekly Pay: Starting __________ Ending _______
Nick Name (known by) ___________________________________________________________________
Reason for Leaving: ______________________________________________________________________
Name of Employer ______________________________________________________________________
Address________________________________________________________________________________
No.
Street
City
State
Zip
Type of Business ________________________________________________________________________
Telephone No. (
)
Your Supervisor's Name _______________________
Your Position and Duties _________________________________________________________________
Date of Employment: From _________ To __________ Weekly Pay: Starting __________ Ending _______
Nick Name (known by) ___________________________________________________________________
Reason for Leaving: ______________________________________________________________________
Note: Attach any additional page(s) as necessary
Military Service
Have you ever served in the U.S. Armed Forces? Yes ____ No ____
Have you obtained any special skills or abilities as the result of service in the military? Yes ____ No ____ If
so, describe:
______________________________________________________________________________________
References
List below three persons not related to you who have knowledge of your work performance within the last three years.
Name _________________________________________________________________________________
Address _______________________________________________________________________________
No.
Street
City
State
Zip
How do you know them?
_______________________________________________________________________________________
Telephone No. (
)
Nick Name (known by) ________________________
Name _________________________________________________________________________________
Address ______________________________________________________________________________
No.
Street
City
State
Zip
How do you know them?
_______________________________________________________________________________________
Telephone No. (
)
Nick Name (known by) ________________________
Name _________________________________________________________________________________
Address ______________________________________________________________________________
No.
Street
City
State
Zip
How do you know them?
________________________________________________________________________________________
Telephone No. (
)
Nick Name (known by) ________________________
Page 4
Please Read Carefully, Initial Each Paragraph and Sign Below
I hereby certify that I have not knowingly withheld any information that might adversely
affect my chances for employment and that the answers given by me are the truth and correct
to the best of my knowledge. I further certify that I, the undersigned applicant, have personally
completed this application. I understand that any omission or misstatement of material fact on
this application or on any document used to secure employment shall be grounds for rejection
of this application or for immediate discharge if I am employed, regardless of the time elapsed
before discovery.
I hereby authorize the company to thoroughly investigate my references, work record,
education and other matters related to my suitability for employment and, further, authorize the
references I have listed to disclose to the company any and all letters, reports and other
information related to my work records, without giving me prior notice of such disclosure. In
addition, I hereby release the company, my former employers and all other persons,
corporations, partnerships and associations from any and all claims, demands or liabilities
arising out of or in any way related to such investigation or disclosure.
I hereby agree to submit to binding arbitration all disputes and claims arising out of the
submission of this application. I further agree, in the event that I am hired by the company,
that all disputes that cannot be resolved be informal internal resolution which might arise out
of my employment with the company, whether during or after that employment, will be
submitted to binding arbitration. I agree that such arbitration shall be conducted under the
rules of the American Arbitration Association. This application contains the entire agreement
between the parties with regard to dispute resolution, and there are no other agreements as to
dispute resolution, either oral or written.
I understand that nothing contained in the application, conveyed during any interview,
which may be granted, or during my employment, if hired, is intended to create an
employment contact between the company and me. In addition, I understand and agree that if I
am employed, my employment is for no definite or determinable period and may be
terminated at any time, with or without prior notice, at the option of either myself or the
company, and that no promises or representations contrary to the forgoing are binding on the
company unless made in written and signed by me and the company's designated
representative.
I hereby agree to submit to a pre-hire physical and or drug test, paid for by the company,
which would be used as a consideration for employment.
Date _________________ Applicant's Signature __________________________________
download Employment Application An Equal Opportunity Employer
