AAA Blue Grass/Kentucky

Employment

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis, including race, color, age, sex, religion, disability or national origin. Consistent with the Americans With Disabilities Act, applicants may request accommodations needed to participate in the application process.

Fields marked with an asterisk (*) are optional. When you have completed the form, click on the Submit button to send your application.

Personal Information
Social Security #
Date of Birth	format as mm/dd/yyyy
Last Name
First Name
Middle Name
Present Address
City
State
ZIP Code
E-Mail Address
Phone No.
Alternate Phone No.*
Referred by*

Employment Desired
Position
Date You Can Start
Salary Desired

Employment History
Are you employed now?	Yes No
If so may we contact your present employer?	Yes No
Have you ever applied with AAA before?	Yes No
If so, where?
when?
Do you have any relatives employed by AAA?	Yes No
If so, where?
Name?
Have you been convicted of a crime in the last five years?	Yes No
If so, Please list details:	*Conviction will not necessarily bar you from employment, but will be judged on its own merits. (Include traffic violations, DUI, etc.)

Education
High School
Name and Location of School
No. of Years Completed
Graduated?	Yes No
College or Trade/Business School
Name and Location of School
No. of Years Completed
Graduated?	Yes No
Subjects Studied and Degree(s) Received

General
Subjects of Special Study or Research Work
Job-Related Skills (typing, driver's license, wpm, CRT, telephone switchboard, radio dispatching, Word, Windows, etc.)

List below your last four employers, starting with the most recent one first.

Former Employers
Employer One
Employer
Dates (mm/yyyy) From:	To:
Salary (beginning)
Salary (upon leaving)
Reason for Leaving
Supervisor's Name
Address of Employer
Position
May we contact this employer?	Yes

Employer Two
Employer
Dates (mm/yyyy) From:	To:
Salary (beginning)
Salary (upon leaving)
Reason for Leaving
Supervisor's Name
Address of Employer
Position
May we contact this employer?	Yes

Employer Three
Employer
Dates (mm/yyyy) From:	To:
Salary (beginning)
Salary (upon leaving)
Reason for Leaving
Supervisor's Name
Address of Employer
Position
May we contact this employer?	Yes

Employer Four
Employer
Dates (mm/yyyy) From:	To:
Salary (beginning)
Salary (upon leaving)
Reason for Leaving
Supervisor's Name
Address of Employer
Position
May we contact this employer?	Yes

Additional References
Name
Relationship
Years Acquainted
Address
Phone No.

Name
Relationship
Years Acquainted
Address
Phone No.

Please read the following disclosure and scroll down to submit this application.

If you are hired by a Company, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements.

AUTHORIZATION

I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the Company.

I understand that any employment is conditioned on a background check. I authorize the Company to thoroughly investigate all statements contained in my application or resume, and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to the Company, without giving me prior notice of such disclosure. In addition, I release the Company, any former employers and all references listed above from any and all claims, demands, or liabilities arising out of or related to such investigation or disclosure.

I understand and agree that nothing contained in this application, or conveyed during my interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be "at will" and without fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or the Company. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the Company unless made in writing.

I understand that filling out this form does not indicate there is a position open and does not obligate the Company to hire. If hired, I agree to abide by all Company work rules, policies, and procedures. The Company retains the right to revise its policies or procedures, in whole or in part, at any time.

Secured by VeriSign.

This page was last updated September 28, 2005 by NS.

This site was designed using PNG images and W3C standards for XHTML and CSS, which are better viewed in Firefox.