Employment Survey:

Job Title (select one):

Shop Managers
Shift Manager
Mechanics
Customer Service Reps

Select Location:

Corbin, KY Lebanon Jct, KY Pendleton, KY Memphis, IN

First Name:

Last Name:

Day Phone:

Evening Phone:

Email:

Address:

City:

State:

Zip:

High School

Name:

Location:

Graduation Year:

College or Technical School

Name:

Location:

Dates Attended:

Degree/Certificate

Most Recent Experience

Employer:

Location:

Position:

Dates:

Major Responsibilities:

Most Recent Position:

Salary/hourly wage at last position:

What is your target annual salary?

Last bonus amount and when:

Why you are no longer with this employer?

What is your current employment status? Employed or Unemployed:

Highest number of employees you supervised directly/indirectly in retail,
restaurant or automotive/truck service:

When could you begin work:

What best describes where you have gained the most experience within the last 10 years:

Select the best match for the time you have worked for your
current or most recent employer: Less 6 months 1 to 2 years 2 to 3 years 3 to 4 years 4 to 5 years More than 5 years

Why do you want to leave your current or most recent employer?



Other Employment

Employer:

Location:

Position:

Dates:

Major Responsibilities:

Pre-Employment

Do you have a valid drivers license? Yes No

Have you ever been convicted of an unpardoned felony within the past 10 years? Yes No

Please pick a total of number of companies that have employed you in the past 10 years: 1 2 3 4 5 6 7 More

Can you provide proof of eligibility to work in the U.S.? Yes No

Are you willing to agree to the following prescreen processes:

Drug Test: Yes No

Background Credit Check: Yes No

Criminal Background Check: Yes No

Are you at least 18 years old? Yes No

Other Information: