Contact Bretz RV & Marine About Employment

Position(s) Applied For

Date of Application

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PERSONAL:

First Name	Middle Name	Last Name
Street Address
City	State	Zip Code
Telephone Number	Email

If you are under 18 years of age, can you provide required proof of your eligibility to work?				Yes No
Have you ever filed an application with us before?				Yes No
			If Yes, give date
Have you ever been employed with us before?				Yes No
			If Yes, give date
Are you currently employed?				Yes No
May we contact your present employer?				Yes No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment.				Yes No
On what date would you be available for work?
Are you available to work:		Full Time Part Time Shift Work Temporary
Are you currently on "lay-off" status and subject to recall?				Yes No
Can you travel if a job requires it?				Yes No
Have you been convicted of a felony within the past 7 years? Conviction will not necessarily disqualify an applicant from employment.				Yes No
If Yes, please explain:

Education

	No. of Years Completed	Did You Graduate	List Diploma or Degree
Elementary School
High School		Yes No
Describe Course of Study:
Undergraduate College/University		Yes No
Describe Course of Study:
Graduate / Professional		Yes No
Describe Course of Study:

Describe any specialized training, apprenticeship, skills and extra-curricular activities:

Describe any honors you have received:

State any additional information you feel may be helpful to us in considering your application.

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Indicate any foreign languages you can speak, read and / or write.

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List professional, trade, business or civic activities and offices held. You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, or handicap or other proteted status:

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Give name, address and telephone number of three references who are not related to you and are not previous employers.

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Have you ever had any job-related training in the United States military?	Yes No
If Yes, please describe:
Are you physically or otherwise unable to perform the duties of the job for which you are applying?	Yes No

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Name and Address of Company:	From:	To:
Type of Business and Phone Number:	Salary:
Describe the work that you did:	Reason for Leaving:
Supervisor's Name:

EMPLOYMENT EXPERIENCE:

Name and Address of Company:	From:	To:
Type of Business and Phone Number:	Salary:
Describe the work that you did:	Reason for Leaving:
Supervisor's Name:

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Name and Address of Company:	From:	To:
Type of Business and Phone Number:	Salary:
Describe the work that you did:	Reason for Leaving:
Supervisor's Name:

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Name and Address of Company:	From:	To:
Type of Business and Phone Number:	Salary:
Describe the work that you did:	Reason for Leaving:
Supervisor's Name:

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Special Skills and Qualifications Summarize special job-related skills and qualifications acquired from employment or other experience.

Employment Data Record:

Employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other legally protected status. As an employer with an Affirmative Action Program, we comply with government regulations, including Affirmative Action responsibilities where they apply. The purpose for this Data Record is to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the govemment on the following information. The completion of this Data Record is optional. If you choose to volunteer the requested information please note that all Data Records are kept in a Confidential File and are not a part of your Application for Employment or personnel file. Please note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY .EMPLOYMENT DECISION:

Applicant's Statement:

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will'' nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

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Full Name:

Date: