BEFORE FILLING OUT
THIS APPLICATION PLEASE READ IT OVER CAREFULLY. ANSWER EACH
QUESTION AND EXPLAIN EACH ANSWER IN AS MUCH DETAIL AS POSSIBLE.
IF YOU HAVE A QUESTION
OR NEED ASSISTANCE IN FILLING OUT THE APPLICATION WE WILL HELP
YOU. WE CONSIDER APPLICANTS
FOR ALL POSITIONS WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN OR ANY OTHER
LEGALLY PROTECTED STATUS.
YOUR PERSONAL INFO
Salutation *
select
Mr.
Ms.
Mrs.
Dr.
Your First Name *
Your Last Name *
Email *
Telephone No *
Cell Phone No *
Alt Phone No *
SSN
Home Address *
City *
State *
select
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Zip *
Birth Date
U.S. Citizen?
select
Citizen
Resident Alien
Visa Work Permit
DRIVING INFO
License State
AK
select
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Lic. Number
Lic. Class
select
A
B
C
D
E
F
G
Lic. Expiration
CDL?
select
no
yes
Years Driving
AVAILABILITY
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
From:
anytime
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12:30pm
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anytime
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anytime
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anytime
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anytime
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anytime
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To:
anytime
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anytime
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anytime
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anytime
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EMERGENCY CONTACT INFO
Contact 1
Contact 2
Name
Name
Relationship
Relationship
Phone1
Phone1
Phone2
Phone2
EMPLOYMENT INFORMATION
Date Available
Position Requested
select
Any
Valet Driver
Parking Lot Attendant
Cashier
Limo Driver
CDL Driver
Hire Type
select
Temporary
Seasonal
Part Time
Full Time
Currently Employed?
select
no
yes
Can you drive a manual transmission?
select
no
yes
Have you ever worked for MidPark Services in the
past?
select
no
yes
Do you have experience in the requested position?
select
no
yes
Have you had any vehicular
accidents in the past 2 years?
select
no
yes
If yes, explain:
Have you had been convicted of a
crime?
select
no
yes
If yes, explain:
Do you have any physical
impairment that could keep you from being available or doing the
job?
select
no
yes
If yes, explain:
Have you ever been discharged
from a position?
select
no
yes
If yes, explain:
If you are currently employed,
who is your employer?
Name
Phone
Can we contact?
select
no
yes
EMPLOYMENT HISTORY
EDUCATION
Are you currently enlisted in the
military?
select
no
yes
Are you a veteran?
select
no
yes
How did you here of us?
*
please select
citypaper
craiglist
backpages.com
employee
employment agency
websearch
other
* Required
I hereby certify that the information hereunder is correct to the best of my
knowledge and understand that falsification of this information is grounds for
refusal to hire or, if hired, dismissal. I hereby authorize any of the persons
or organizations listed in my application to give all information concerning my
previous employment, education, or any other information that might have,
personal or otherwise, with regard to any of the subjects covered by this
application, and release all such parties from all liability that may result
from furnishing such information to you. I authorize you to request and receive
such information. In consideration for my employment and my being considered for
employment by your company, I agree to adhere to the rules and regulations of
the company and hereby acknowledge that these rules and regulations may be
changed by your company at any time, at the company's sole option and without
any prior notice. In addition, I acknowledge that my employment may be
terminated, and any offer of employment, if such is made, my be withdrawn with
or without prior notice, any any time, at the option of either the company or
me. I understand that no representative of the company has any authority to
enter into any agreement for employment for any specified period of time, or to
assure or make some other personnel move, either prior to commencement of
employment or after I have become employed, or to assure any benefits or terms
and conditions of employment, or to make any agreement, that is contrary to the
foregoing. I hereby acknowledge that I have been advised that this application
will remain active for no more than 90 days from the date it was signed.
Type in Your Full Name and Today's Date (dd/mm/yyyy)