Honda Suzuki North

Employment Application

Availability

Do you have reliable transportation to get to work?	yes no
If hired, when could you begin work? (Month/Day/Year)
How many hours would you like to work each week?

Education

HIGH SCHOOL
Name	City, State	Years Completed
GPA	Degree or Diploma	Contact Person
COLLEGE
Name	City, State	Years Completed
GPA	Degree or Diploma	Contact Person
OTHER
Name	City, State	Years Completed
GPA	Degree or Diploma	Contact Person

Work Experience

1. Company	May we contact them? yes no
Address	Position and Duties	Supervisor-Name, Phone
Dates Employed	Ending Wage	Reason for Leaving
2. Company	May we contact them? yes no
Address	Position and Duties	Supervisor-Name, Phone
Dates Employed	Ending Wage	Reason for Leaving
3. Company	May we contact them? yes no
Address	Position and Duties	Supervisor-Name, Phone
Dates Employed	Ending Wage	Reason for Leaving

References
List three personal, school or work references who we may contact. Do not list people who are related to you.

1. Reference Name

Phone Number

How long have you known this person?
What is their relationship to you?
Type of reference: Personal, School, Work

2. Reference Name

Phone Number

How long have you known this person?
What is their relationship to you?
Type of reference: Personal, School, Work

3. Reference Name

Phone Number

How long have you known this person?
What is their relationship to you?
Type of reference: Personal, School, Work

Applicant's Statements
Read the following statements carefully before submitting this application. Only applications that are fully completed and dated are considered valid.

The information I am presenting in this application is complete, true and correct to the best of my knowledge. I understand that any falsification, misrepresentation, or omissions could result in the denial of my application, withdrawal of any offer of employment or immediate discharge.
I understand that in connection with the application process, Honda Suzuki North and its representatives may contact my former employers, educational institutions, references and other relevant third parties to obtain additional information related to the information given by me in this application. I also understand that Honda Suzuki North may provide such information to its parent company and affiliates and to other third parties. I hereby request, release and consent to the release and disclosure of such information. I further release and hold harmless Honda Suzuki North, Honda Suzuki North's parent company and affiliates, their officers, employees and agents, and any other parties inquiring about, investigating, furnishing, communicating, reviewing, or evaluating such information from any and all potential claims, demands, damages, liabilities, and/or actions of any kind arising from such activities, whether known or unknown to me presently, that I may have, now or in the future.

Name

Date

Name (First, Middle, Last)	E-mail Address
Street Address	City, State, ZIP
How long at current address?	Your Phone Number
Emergency Contact Name	Emergency Contact Phone Number

Are you under the age of 18?	yes no
If "yes," can you, after employment, show proof of age?	yes no
Can you, after employment, submit certification of your legal right to work in the U.S.?	yes no
Have you ever been counseled or disciplined for being late or absent from work or school?	yes no
Have you ever been convicted of a felony, a crime involving dishonesty, or a crime involving violence to another person?	yes no
If "yes," please describe, including dates charged, penalties and current disposition.