Hampton Roads, Virginia Diesel Engine Employment Opportunities

Employment Application

General Information

* denotes required field

When entering the date in this application use 01/01/2006 format or the calendars provided.

Full Name:
	Last *	First*	M.I.

Address:
	Street Address*	Apt/Unit#


	City*	State*	Zip*

Contact:
	Phone ( ) 555-1212*	Cell ( ) 555-1212	Email*

Other Info (required)
*U.S Citizen?	Yes No
*Authorized to work in US?	Yes No
*Felony Conviction?	Yes No
*Have your own tools?	Yes No
*Date Available:

Military Serice
Branch:
From:
To:
Rank at Discharge:
Type of Discharge:

Education & Training

*High School:

Street Address:

*City:

*State:

*Zip:

*From:

*To:

*Grad:

Yes No

School:

Course of Study:

From:

To:

Grad:

Yes No

School:

Course of Study:

From:

To:

Grad:

Yes No

References

Please list three professional references

*Full Name:		*Relationship:
*Company:		*Phone:	ex. (757) 555-1212

*Full Name:		*Relationship:
*Company:		*Phone:	ex. (757) 555-1212

*Full Name:		*Relationship:
*Company:		*Phone:	ex. (757) 555-1212

Previous Employment

*Company:

*Supervisor:

*Address:

*City:

*State:

*Zip:

*Job Title:

*From:

*To:

*Starting Wage:

$ /hr

*Ending Wage:

$ /hr

*May we contact your Supervisor:

Yes No

Reason for Leaving:

Company:

Supervisor:

Address:

City:

State:

Zip:

Job Title:

From:

To:

Starting Wage:

$ /hr

Ending Wage:

$ /hr

May we contact your Supervisor:

Yes No

Reason for Leaving:

Company:

Supervisor:

Address:

City:

State:

Zip:

Job Title:

From:

To:

Starting Wage:

$ /hr

Ending Wage:

$ /hr

May we contact your Supervisor:

Yes No

Reason for Leaving:

Company:

Supervisor:

Address:

City:

State:

Zip:

Job Title:

From:

To:

Starting Wage:

$ /hr

Ending Wage:

$ /hr

May we contact your Supervisor:

Yes No

Reason for Leaving:

Certifications and Specific Experience

Briefly list any factory certifications you have and which equipmemt - manyfacturer and model - you have worked on. Indicate what you have done with each equipment, i.e. "Overhaul", "Repair", or "Service". If you are applying for a job other than as a service technician, briefly describe your special qualifications and/or experience.

characters left:

Disclaimer and Siganture

I certify that my answers are true and complete to the best of my knowledge. Further, I understand that if this application leads to employment, then any false or misleading information in my application or interview may result in the termination of employment.

I herby authorize Bay Diesel & Generator to call anyone in the Reference section listed above about my character and work skills, and authorize Bay Diesel & Generator, after I am hired, to call any company listed in the Previous Employment section to verify the information I provided.

By entering your full name below you are in compliance with the above disclaimer and are "Signing" this application.

Sign Here

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