POSITION ALL REQUIRED FIELDS MARKED WITH AN ASTERISK (*).

_

  Middle Name :   Last Name* :

  City* :   State* :   Zip code* :

 Date  Year :

Employment Information

     

     

     

     

(SUMMARIZE SPECIAL SKILLS AND QUALIFICATIONS ACQUIRED FROM EMPLOYMENT OR OTHER EXPIERENCES THAT MAY QUALIFY YOU FOR WORK WITH OUR COMPANY.)

General Information

     

     

(Proof of U.S. Citizenship OR INS status is Required.)

     

I am aware that upon submission of Cook Tire & Service Center's application all potential applications are subject to background check and drug screening.

Educational Background
SCHOOL NAME / LOCATION YEARS COMPLETED DID YOU GRADUATE? COURSE OF STUDY
HIGH SCHOOL
* * *   *
COLLEGE
Yes  No
TRADE / TECHNICAL SCHOOL
Yes  No
Employment history

LIST YOUR LAST (3) EMPLOYERS, ASSIGNMENTS, OR VOLUNTARY ACTIVITES (AL LEAST 5 YEARS), STARTING WITH THE MOST RECENT, INCLUDING MILITARY EXPERIENCE.

FROM* TO* EMPLOYER* PHONE*
JOB TITLE* ADDRESS*
SUPERVISOR/TITLE* NATURE OF WORK/JOB RESPONSIBILITIES*
HOURLY RATE/SALARY* REASON FOR LEAVING*
START $ PER

END    $ PER
FROM TO EMPLOYER PHONE
JOB TITLE ADDRESS
SUPERVISOR/TITLE NATURE OF WORK/JOB RESPONSIBILITIES
HOURLY RATE/SALARY REASON FOR LEAVING
START $ PER

END    $ PER
FROM TO EMPLOYER PHONE
JOB TITLE ADDRESS
SUPERVISOR/TITLE NATURE OF WORK/JOB RESPONSIBILITIES
HOURLY RATE/SALARY REASON FOR LEAVING
START $ PER

END    $ PER
UPON SUBMISSION OF THIS FORM, IT IS UNDERSTOOD AND AGREED UPON THAT ANY MISREPRESENTATION BY ME IN THIS APPLICATION WILL BE SUFFICIENT CAUSE FOR CANCELLATION OF THIS APPLICATION AND/OR SEPARATION FROM THE EMPLOYER’S SERVICE IF I HAVE BEEN EMPLOYED.

I GIVE THE EMPLOYER THE RIGHT TO INVESTIGATE ALL REFERENCES AND TO SECURE ADDITIONAL INFORMATION ABOUT ME, IF JOB RELATED. I HEREBY RELEASE FROM LIABILITY THE EMPLOYER AND ITS REPRESENTATIVES FOR SEEKNG SUCH INFORMATION, AND ALL OTHER PERSONS, CORPORATIONS OR ORGANIZATIONS FOR FURNISHING SUCH INFORMATION.

THE EMPLOYER IS AN EQUAL OPPORTUNITY EMPLOYER. THE EMPLOYER DOES NOT DISCRIMINATE IN EMPLOYMENT AND NO QUESTION ON THIS APPLICATION IS USED FOR THE PURPOSE OF LIMITING OR EXCUSING ANY APPLICATIONS CONSIDERATION FOR EMPLOYMENT ON A BASIS PROHIBITED BY LOCAL, STATE, OR FEDERAL LAW.

THIS APPLICATION IS CURRENT FOR ONLY 60 DAYS. AT THE CONCLUSION OF THIS TIME, IF I HAVE NOT HEARD FROM THE EMPLOYER AND STILL WISH TO BE CONSIDERED FOR EMPLOYMENT, IT WILL BE NECESSARY TO FILL OUR A NEW APPLICATION.

I UNDERSTAND THAT JUST AS I AM FREE TO RESIGN AT ANY TIME, THE EMPLOYER RESERVES THE RIGHT TO TERMINATE MY EMPLOYMENT AT ANY TIME, WITH OR WITHOUT CAUSE AND WITHOUT PRIOR NOTICE. I UNDERSTAND THAT NO REPRESENTATIVE OF THE EMPLOYER HAS THE AUTHORITY TO MAKE ANY ASSURANCES TO THE CONTRARY.

BY COMPLETING AND SUBMITTING THIS APPLICATION FOR EMPLOYEMENT, I UNDERSTAND AND AGREE THAT COOK TIRE & SERVICE CENTER (THE “COMPANY”), HAS A DISPUTE RESOLUTION PLAN, WHICH IS INCORPORATED BY REFERENCE IN THIS APPLICATION. THIS PLAN IS THE REQUIRED AND EXCLUSIVE WAY FOR APPLICANTS, EMPLOYEES AND THE COMPANY TO RESOLVE ANY AND ALL DISPUTES. I AGREE TO RESOLVE ANY DISPUTE BETWEEN THE COMPANY AND ME ARISING OUT OF THIS APPLICATION OR, IF THE COMPANY HIRES ME, OUT OF MY EMPLOYMENT, THROUGH THE DISPUTE RESOLUTION PLAN, WHICH INCLUDES BINDING ARTBITRATION AS A FINAL STEP.

PLEASE FILL OUT ALL REQUIRED FIELDS. FORM WILL NOT SUBMIT UNLESS COMPLETE. ALL REQUIRED FIELDS MARKED WITH AN ASTERISK (*).