MIKE ERDMAN AUTOMOTIVE
DISCLOSURE AND AUTHORIZATION FOR RELEASE OF INFORMATION
As part of our driver controls, we may obtain motor vehicle reports (MVRs) on your driving history. Before we seek such reports, we wish to have your written permission to obtain the information. You have the right, upon written request, to a copy of the MVR.
AUTHORIZATION AND RELEASE TO OBTAIN MVR INFORMATION
Under the provisions of the Fair Credit Reporting Act, 15 USC, Section1681 et seq., the Americans with Disabilities Act and all applicable federal, state, and local laws, I hereby authorize and permit member companies of Willis, including Willis Programs, member companies of AIG, my employer, and/or my employer's insurance agent to obtain a MVR.
I agree that a copy of this authorization has the same effect as an original.
I hereby release and hold harmless and person, firm, or entity that discloses mattersin accordance with this authorization, from liability that might otherwise result from the request for use of and/or disciosure of any or all of the foregoing information.
I understand and acknowledge that I may request a copy of my MVR after I have provided proper identification.
Member companies of Willis including Willis Programs, member companies of AIG, my employer, and/or my employer's insurance agent have the continuing right and authority to check and deliver my motor vehicle records on file with the State or other resource, including, without limitation, driving record, financial responsibility information and prior driving information as set forth above and to deliver such records to one another and the company.
AUTHORIZATION FOR PRIOR EMPLOYER TO RELEASE INFORMATION
I hereby authorize my prior employers to release any and all information relating to my employment with them to Mike Erdman Motors. I further release and hold harmless the companies involved from any and all liability that may potentially result from the release and/or use of such information. I understand that any information released by my prior employers will be held in strictest confidence, that will be viewed only by those involved in the hiring decision, and that neither I nor anyone else not so involved will have right to see the information.
Dealership
Application for Employment
Position Desired: Full-time Part-time Date:
WE ARE AN EQUAL OPPORTUNITY EMPLOYER
APPLICANT'S STATEMENT
I agree that any dispute between me and the dealership related to my application for employment or my employment, if selected, will be resolved through mutually binding arbitration in accordance with the dealership's arbitration policy and procedure. I understand that I have the right to review the policy and procedure prior to signing this statement.
I understand that if I am hired, my employment will be for no definite period, regardless of the period of payment of my wages. I further understand that I have the right to terminate my employment at will at any time with or without notice or reason, and the Company has the same right. No one other than the President of the Company has authority to modify this relationship or make any agreement to the contrary. Any such modification or agreement must be in writing.
I understand that the company reserves the right to require me to submit to a drug test at any time and also reserves the right to require me to submit to an alcohol test and/or medical examination to the extent permitted by law. I further understand that the Company may contact my previous employers and I authorize those employers to disclose to the Company all records and other information pertinent to my employment with them. I release my previous employers from any liability as a result of their disdosure of information about me to the Company. I also authorize the Company to provide truthful information concerning my employment with it to my future prospective employers and I agree to hold It harmless for providing such information
I further understand that if employed I will be on a 90-day introductory period, and that termination for unsatisfactory performance during that period will not result in any Company responsibility for unemployment benefits. I further understand that completion of the Introductory period does not confer any expectation of continued employment, and that if employed, my employment will be for no definite period and "at-will."
By Signing below, I certify that all of the information that I provide on this application and to any interview will be true, complete and accurate. I understand that if I am employed and any such information is later found to be false or misleading in any respect, I will be dismissed.
I certify that I have received a written notification that the Company may obtain a consumer report or reports on me. I authorize this Company to obtain such report or reports for use in connection with my application for employment and for other employment related reasons. If hired, this authorization will remain on file and serve as ongoing authorization for pror;urement of employment-related consumer reports at any time during my employment. I understand that the term, "consumer report" inciudes, but is not limited to, credit checks, Criminal background checks, department of motor vehicle reports, and investigative consumer reports. I further understand that the term "investigative consumer report" means a report in which information on my character, general reputation, personal characteristics, or mode of living is obtained through personal Interviews with my neighbors, friends, or associates or with others with whom I am acquainted or who may have knowledge concerning any such Items of information.
Do not sign until you have read and understand this statement
RECORD OF PREVIOUS EMPLOYMENT
Please list the names of your previous employers in chronological order with present or last employer listed first. Be sure to account for all periods of time, including military service and any period of unemployment. If self-employed, give firm name and supply business references.
List all other employers you have had in the last ten (10) years:
Have you ever been terminated or asked to resign from any job? Yes No
If yes, please explain circumstance:
Please explain fully any gaps in your employment history:
CHARACTER REFERENCES
Please list persons who know you well - not previous employers or relatives
Do you have a current driver's license? Yes No
State: License No.: Expiration Date:
Has your driver's license ever been suspended or revoked? Yes No
If yes, please explain circumstances:
Do you have personal automobile insurance? Yes No Name of Ins. Company:
Has your personal automobile insurance ever been cancelled? Yes No
Have you ever been cited for driving under the influence (DUI) or driving while intoxicated (DWI)? Yes No
If yes, please explain circumstances and outcome:
Please list all moving traffic violations in the last five (5) years:
This application will be considered active for a maximum of thirty (30) days. If you wish to be considered for employment after that time, you must reapply.
I certify that all of the information that I have provided on this application is true and accurate.
This company is an equal opportunity employer and does not discriminate because of race, color, religion, sex, age, citizenship, marital status, disability, or national origin.
ADDITIONAL INFORMATION
Please indicate any actual experience you have in any of the following positions:
EDUCATION
