Driver Application

In Compliance with Federal and State equal employment opportunity laws,
qualified applicants are considered for all positions without regard to
race, color, religion, sex, national origin, age, marital status, veteran
status, non job related disability, or any other protected group status.

Position Applied for *

Full Name. Last, First, Middle * Title First Last Suffix
Date of birth * MM / DD / YYYY Pick a date.
Phone Number *
Email

List your addresses of residency for the past 3 years. *

Current Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
How long at the above address? yr/mo *

Previous Address (if needed)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
How long at the above address? yr/mo

Previous Address (if needed)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
How long at the above address? yr/mo

Previous Address. (if needed)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

How long at the above address? yr/mo

Do you have a legal right to work in the United States? *
Yes No

Can you provide proof of age? *
Yes No

Have you worked for Star Collision Centers before? *
Yes No
If yes where?

Rate of pay

Position

Date Started MM / DD / YYYY Pick a date.

Date Left MM / DD / YYYY Pick a date.

Reason for leaving?

If not currently employed how long since your last employment? *

Who referred you?

Rate of pay expected?

Have you ever been bonded? (only answer if a job requirement) *
Yes No

If you have been bonded before, name of bonding company?
Have you ever been convicted of a felony> *
Yes No
If yes please explain. Conviction of a crime is not an automatic bar
from emplyment. All circumstances will be considered

Is there any reason you might be unable to perform the functions of
the job for which you have applied? *
Yes No
If yes, please explain if you wish.

I authorized Star Collision Center to recieve the above information and
the use all of it's content for possible employment purposes. *
Check box if you agree to the above statement.

Is the person that authorized the above statement the applicant? *
Yes

Drivers Application Step Two (Empolyment History)

All driver applicants to drive in interstate commerce must provide the following
information on all employers during the preceding 3 years. List complete mailing
address, street number, city, state, and zip code.

Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce
shall also provide an additional 7 years employers in reverse order starting with the most recent.

*Includes vehicles having a GVWR of 36,001 lbs. or more, vehicles designed to transport
15 or more passengers or any size vehicle used to transport hazardous materials in a
quantity requiring placarding.

Name * Title First Last Suffix
Social Security Number *
Phone Number *
Email

Employer One *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
From * MM / DD / YYYY Pick a date.
To * MM / DD / YYYY Pick a date.
Contact Person * First Last
Phone Number *

Did you drive a vehicle requiring a CDL? *
YES NO

Position Held *

Salary/Wage *

Reason for leaving *

Employer Two
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
From MM / DD / YYYY Pick a date.
To MM / DD / YYYY Pick a date.
Contact Person First Last
Phone Number

Did you drive a vehicle requiring a CDL?
YES NO

Position Held

Salary/Wage

Reason for leaving

Employer Three
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
From MM / DD / YYYY Pick a date.
To MM / DD / YYYY Pick a date.
Contact Person First Last
Phone Number

Did you drive a vehicle requiring a CDL?
YES NO

Position Held

Salary/Wage

Reason for leaving

Employer Four
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
From MM / DD / YYYY Pick a date.
To MM / DD / YYYY Pick a date.
Contact Person First Last
Phone Number

Did you drive a vehicle requiring a CDL?
YES NO

Position Held

Salary/Wage

Reason for leaving

List Additional Employment Hsitory Here. (if needed)

I have completed Driver Appilcation Step One *
YES NO

I authorize Star Collision Centers Inc. to use this information about my employment history for purposes applicable by Federal and State employment laws. *
YES NO