ONLINE APPLICATION

PERSONAL INFORMATION:

Last Name	First Name	Middle Name
Age	Home Telephone:	Cell Telephone:
Present Address:	City	State
Zip Code	Are you at least 18 years old? Yes No
Have you ever been fired from a job? Yes No
If you answered “Yes”, please explain:
Have you ever, under your name or another name, been convicted of or plead no contest to a criminal offense other than a minor traffic violation? Yes No
If you answered “Yes”, please state the nature of the offense and disposition of case. Felony convictions or existence of a criminal record does not constitute an automatic bar to employment:
EMPLOYMENT DESIRED:
Position applying for:

Are you applying for (please check one): Regular full-time position Part-time position Temporary position
Are you available to work weekends? Yes No
Have you ever applied to or worked for United Group? Yes No
If hired, do you have a reliable means of transportation to and from work? Yes No
Do you have a cell phone? Yes No
If hired, on what date can you start?
Wages desired?
Do you have any friends or relatives working for United Group? Yes No
If yes, name and relationship(s)
How did you hear about us?

Education, Training and Experience:
High School:	Did you graduate? Yes No
College:	Did you graduate? Yes No
Vocational:	Did you graduate? Yes No
Do you have any other experience, training, qualifications or skills which you feel make you especially suited to work for us? Yes No
If yes, please explain:
Education, Training and Experience: List below all present and past employment for the past ten (10) years, starting with your most recent or present employer. You must complete this section even if attaching a resume. Resumes may be emailed to info@unitedwindshield.com
Are you employed now? Yes No	If yes, may we inquire of your present employer? Yes No
1. Name of employer
Address:
Telephone No.	Supervisor’s name:
Type of business:	Were you terminated? Yes No
Your position:
Dates of employment / From:	To:
Earnings / Starting:	Ending:
Reason for leaving (please be specific):
2. Name of employer:
Address:
Telephone No.	Supervisor’s name:
Type of business:	Were you terminated? Yes No
Your position:
Dates of employment / From:	To:
Earnings / Starting:	Ending:
Reason for leaving (please be specific):
3. Name of employer:
Address:
Telephone No.	Supervisor’s name:
Type of business:	Were you terminated? Yes No
Your position:
Dates of employment / From:	To:
Earnings / Starting:	Ending:
Reason for leaving (please be specific):

AUTHORIZATION

PLEASE READ THE FOLLOWING CAREFULLY, INITIAL EACH PARAGRAPH, THEN SIGN BELOW.

PERSONALLY COMPLETED FORM HONESTLY AND ACCURATELY

BY MY SIGNATURE AND INITIALS PLACED BELOW, I AFFIRM THAT I HAVE PERSONALLY COMPLETED THIS APPLICATION. I DECLARE UNDER PENALTY OF PERJURY THAT THE INFORMATION PROVIDED IN THIS EMPLOYMENT APPLICATION (AND ACCOMPANYING RESUME, IF ANY) IS TRUE AND COMPLETE. I UNDERSTAND THAT ANY FALSE INFORMATION OR SIGNIFICANT OMMISSIONS MAY DISQUALIFY ME FROM FURTHER CONSIDERATION FOR EMPLOYMENT, AND MAY BE JUSTIFICATION FOR MY DISMISSAL FROM EMPLOYMENT IF DISCOVERED AT A LATER TIME. I UNDERSTAND THAT ANY JOB OFFER WILL BE CONDITIONAL BASED ON THE SATISFACTORY REVIEW OF MY QUALIFICATIONS INCLUDING ANY AND ALL BACKGROUND OR DRUG SCREENING WHICH MAY BE REQUIRED

INITIALS

AUTHORIZATION TO OBTAIN INFORMATION

I VOLUNTARILY AND KNOWINGLY AUTHORIZE ANY PRESENT OR PAST EMPLOYER, SUPERVISOR, ADMINISTRATOR, EDUCATIONAL INSTITUTION, LAW ENFORCEMENT AGENCY, PRIVATE BUSINESS, MILITARY BRANCH, PERSONAL REFERENCE, AND/OR OTHER PERSONS, TO GIVE RECORDS OR INFORMATION THEY MAY HAVE CONCERNING MY CRIMINAL HISTORY, EDUCATION, EMPLOYMENT (INCLUDING CHARACTER, EARNINGS, AND REASON FOR LEAVING) OR ANY OTHER INFORMATION REQUESTED BY UNITED GROUP TO DETERMINE MY ELIGIBILITY FOR EMPLOYMENT

INITIALS

RELEASE

I VOLUNTARILY WAIVE ALL RECOURSE AND RELEASE ANY COMPANY, INDIVIDUAL, OR ORGANIZATION FROM LIABILITY FOR COMPLYING WITH ANY REQUEST FROM THE COMPANY OR AGENTS OF THE COMPANY TO OBTAIN ANY INFORMATION FROM ANY SOURCE WHATSOEVER RELATING TO MY APPLICATION FOR EMPLOYMENT. I FURTHER RELEASE UNITED GROUP OR ANY INDIVIDUAL WITHIN UNITED GROUP REGARDING THE USE OF ANY INFORMATION RECEIVED WHICH MAY HAVE BEARING ON MY APPLICATION FOR EMPLOYMENT WITH UNITED GROUP.

INITIALS

COMPLIANCE WITH RULES

IF I BECOME EMPLOYED WITH UNITED GROUP, I AGREE TO COMPLY WITH THE RULES, REGULATIONS AND POLICIES OF THE COMPANY.

INITIALS

AGREEMENT FOR ARBITRATION

I HEREBY AGREE TO SUBMIT TO BINDING ARBITRATION OF ALL DISPUTES AND CLAIMS ARISING OUT OF THE SUBMISSION OF THIS APPLICATION. I FURTHER AGREE, IN THE EVENT THAT I AM HIRED BY UNITED GROUP, THAT ALL DISPUTES THAT CANNOT BE RESOLVED BY INFORMAL INTERNAL RESOLUTION WHICH MIGHT ARISE OUT OF MY EMPLOYMENT WITH UNITED GROUP, WHETHER DURING OR AFTER THAT EMPLOYMENT, WILL BE SUBMITTED TO BINDING ARBITRATION PURSUANT TO THE COMPANY’S DISPUTE RESOLUTION POLICY.

INITIALS

AT-WILL EMPLOYMENT

I UNDERSTAND AND AGREE THAT NOTHING CONTAINED IN THIS APPLICATION OR OTHER DOCUMENT, OR CONVEYED DURING ANY INTERVIEW WHICH MAY BE GRANTED, OR DURING MY EMPLOYMENT IF HIRED, IS INTENDED TO ALTER THE AT-WILL EMPLOYMENT RELATIONSHIP WITH UNITED GROUP.

INITIALS

I certify that all of the information provided by me on this application is true and accurate.
Signature: (Type)	Date:

Comments:

Content on this page requires a newer version of Adobe Flash Player.