DC-772
COMPOSITE MOTORS, INC.
Telephone 352.799.2599
Fax: 352.540.9794
15446 Flight Path Drive
Brooksville, FL 34604-6856
Equal Opportunity Employer
APPLICATION FOR EMPLOYMENT
PERSONAL INFORMATION
DATE
NAME (LAST NAME FIRST)
SOCIAL SECURITY NO.
_
_
PRESENT ADDRESS
CITY
STATE
ZIP CODE
PERMANENT ADDRESS
CITY
STATE
ZIP CODE
PHONE NO.
(
REFERRED BY
)
-
EMPLOYMENT DESIRED
POSITION
DATE YOU CAN START
ARE YOU
EMPLOYED NOW?
IF
YES
NO
SO, MAY WE INQUIRE
OF YOUR PRESENT EMPLOYER? YES
EVER APPLIED TO
THIS COMPANY BEFORE?
SALARY DESIRED
ARE YOU LEGALLY AUTHORIZED
TO WORK IN THE U.S.? YES NO
NO
WHERE?
YES
WHEN?
NO
____I AM SUBMITTING A COPY OF MY RESUME
EDUCATION HISTORY
NAME & LOCATION OF SCHOOL
YEARS
ATTENDED
DID YOU
GRADUATE
SUBJECTS STUDIED
HIGH SCHOOL
COLLEGE
TRADE, BUSINESS OR
CORRESPONDENCE
SCHOOL
GENERAL INFORMATION
SUBJECTS OF SPECIAL
STUDY/RESEARCH WORK
SPECIAL TRAINING
SPECIAL SKILLS
U.S. MILITARY OR
NAVAL SERVICE
RANK
FORMER EMPLOYERS (LIST BELOW LAST FOUR EMPLOYERS WITH LAST ONE FIRST)
DATE
MONTH & YEAR
EMPLOYER NAME
& CONTACT INFO
SALARY
POSITION
REASON FOR LEAVING
FROM
TO
FROM
TO
FROM
TO
FROM
TO
CONTINUED ON OTHER SIDE
REFERENCES GIVE BELOW THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN FOR ATLEAST ONE YEAR
NAME
CONTACT INFO
BUSINESS
YEARS
KNOWN
MEDICAL
I understand that any offer of employment with CMI may be contingent upon my successful completion of any post offer
pre-employment physical examination that CMI may require. I also agree that I may be required to undergo and successfully
pass a screening for alcohol/ or drugs during the hiring process and if employed, as required by CMI, as well as comply with
all post-employment inquiry on my medical history.
AUTHORIZATION & SIGNATURE
READ CAREFULLY BEFORE SIGNING:
1. I understand that the receipt of this application does not imply that I will be employed.
2. The statements and information furnished by me in this application are true and complete. I understand that I will be
subject to immediate dismissal or refusal to hire if any time CMI discovers falsification, omission, or
misrepresentation of fact in this application
3. I understand that I may be required, depending on my position, to sign a non-compete, confidentiality, and/or
business ethics agreement as a condition of my employment.
4. I authorize CMI to conduct a background inquiry to verify the statements and information on this application, other
documentation that I have provided, and other areas that may include prior employment, consumer credit, criminal
convictions, motor vehicle history, and other reports, and agree to execute such Authorizations as are necessary.
5. I understand that all employees of CMI are employees at will, unless a separate employment agreement is entered
into. If hired as an employee at will, I will be free to resign any time. Likewise CMI will have the right to terminate
any employment at will at any time with or without notice, regardless of the date of payment of my wages or salary.
Neither this application, nor any other documents given to employee upon hiring, is intended to create, nor should be
construed as creating, an express or implied contract.
6. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by
The Americans with Disabilities Act (ADA) and other federal and state laws.”
My Signature Certifies That I Have Read, Understood, And Agree With The Above Statements.
Signature of Applicant:
Date:
OFFICE USE ONLY
INTERVIEWED BY
HIRED
DATE
FOR
DEPT.
POSITION
WILL
REPORT
SALARY
WAGES
APPROVED
EMPLOYMENT MANAGER
DEPARTMENT HEAD
GENERAL MANAGER
DC-77X
COMPOSITE MOTORS, INC.
Telephone 352.799.2599
Fax: 352.540.9794
15446 Flight Path Drive
Brooksville, FL 34604-6856
Equal Opportunity Employer
SECURITY QUESTIONNAIRE FOR APPLICANT
PERSONAL INFORMATION
DATE
NAME (LAST NAME , FIRST NAME)
SOCIAL SECURITY NO.
_
_
PREVIOUS NAMES USED
PRESENT ADDRESS
CITY
STATE
ZIP CODE
PERMANENT ADDRESS
CITY
STATE
ZIP CODE
PREVIOUS ADDRESS (IF LESS THAN 3 YEARS)
CITY
STATE
ZIP CODE
PHONE NO.
ALTERNATE PHONE NO.
(
)
-
(
)
-
CRIMINAL BACKGROUND INFORMATION
READ CAREFULLY BEFORE ANSWERING THE FOLLOWING QUESTION:
You may answer “No” if your criminal record consists of only one or more of the following:
(a) a sealed record on file with the Commissioner of Probation of any applicable State,
(b) a case of delinquency or a child in need of services which did not result in a complaint transferred to an Adult Court
(i.e. Superior Court) for criminal prosecution,
(c) your alleged crimes or crimes were misdemeanors and they occurred, or prison sentences ended, ten or more years
ago, or
(d) your misdemeanors were limited to a first offense for drunkenness, simple assault, speeding, minor traffic violations,
affray, or disturbing the peace
Have you been convicted of a felony or a misdemeanor
Yes
No
If yes, for each conviction or arrest give details including date, city and state, nature of offense, and disposition:
Note: A conviction or arrest record will not necessarily be a bar from employment
AUTHORIZATION & SIGNATURE
READ CAREFULLY BEFORE SIGNING:
7. The statements and information furnished by me in this application are true and complete. I understand that I will be
subject to immediate dismissal or refusal to hire if any time CMI discovers falsification, omission, or
misrepresentation of fact in this security questionnaire.
8. I authorize CMI to conduct a background inquiry to verify the statements and information on this application, other
documentation that I have provided, and other areas that may include prior employment, consumer credit, criminal
convictions, motor vehicle history, and other reports, and agree to execute such Authorizations as are necessary.
9. This waiver does not permit the release or use of criminal information in a manner prohibited by
The Americans with Disabilities Act (ADA), EEOC regulations or guides and/or other federal and state laws.
My Signature Certifies That I Have Read, Understood, And Agree With The Above Statements.
Signature of Applicant:
Date: