Miller Auto Marine Employment Application Form NOTE ! PLEASE REFRESH PAGE IF FORM DOESN'T DISPLAY PROPERLY! Instructions: Please enter your information. Answer all questions.

Personal Information Please fill out this form completely.

Name *

Prefix

First *

Last *

Suffix

Address *

Street Address *

Address Line 2

City *

State / Province / Region *

Postal / Zip Code *

Country *

Phone Number *

### - ### - ####

Position Applied For *

EDUCATION: A description of the section goes here.

Name and Address Of School - Degree/Diploma - Graduation Date *

Skills and Qualifications: Licenses, Skills, Training, Awards *

EMPLOYMENT HISTORY: Present Or Last Position:

Employer: *

Supervisor: *

Phone Number *

### - ### - ####

Position Title: *

Start Date *

MM / DD / YYYY

End Date *

MM / DD / YYYY

Responsibilities: *

Salary *

Input hourly wage, if not salaried.

Reason for Leaving: *

Past Employers

Employer: *

Supervisor: *

Phone Number *

### - ### - ####

Position Title: *

Start Date *

MM / DD / YYYY

End Date *

MM / DD / YYYY

Responsibilities: *

Salary *

Input hourly wage, if not salaried.

Reason for Leaving: *

May We Contact Your Present Employer?

Yes   No

May We Contact Your Past Employer(s)?

Yes   No

May We Contact Your References?

Yes   No

Have You Ever Been Convicted of a Crime?

No   Yes

If Yes, Please Explain.

Additional Information, Comments or paste in your Resume:

Legal Disclaimer, Please Read and Initial. I certify that the information provided on the application is true and complete. I agree that if there is any misrepresentation or omission concerning the information on this application, any offer of employment to me may be withdrawn, and if I have already been hired, my employment may be terminated. I understand that any offer of employment by this dealership is contingent upon (1) my providing sufficient documentation necessary to establish my identity and eligibility to work in the United States, (2) successful completion of any preplacement physical exam and/or drug/alcohol test that may be required by the dealership, (3) successful passing of background check(s), and (4) proof of valid driver's license and satisfactory driving record. I understand that my employment may be terminated at any time if the dealership determines or is notified by it's insurer that I do not have a valid driver's license or satisfactory driving record. No promises concerning the nature or length of my employment have been made to me. If I am hired, I understand that I have the right to terminate my employment at any time, and for any reason. Unless I am covered by a collective bargaining agreement containing a contrary provision. I also understand that the dealership has the same right to terminate my employment at any time and for any reason. I understand that no one employed by the dealership as the authority to modify these conditions. I hereby release all persons, past and present employers, and educational institutions from any liability to me if they supply information to this dealership as part of an investigation. My signature/initials reflect that I have read, understood, and have agreed to these terms and conditions. I understand that this application will be considered active for 6 months, and that if I wish to be considered for employment after that, I must submit a new application.

Initial *

Date *

MM / DD / YYYY

Email *

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