Speedemissions, Inc.
1015 Tyrone Road, Suite 710
Tyrone, GA 30290
Employment Application Form
Please complete all sections:
(all items with blue border are required)
Applicant Information:
First Name:
Last Name:
Middle Name or Initial
Maiden
Street:
City:
State:
ZIP
Contact Number
SS#: (OPTIONAL - We can get later)
How long at current address?
Years:
Months:
Are you under the age 18? -->
If YES, can you provide proof of your eligibility to work? -->
Are you currently authorized to work in the United States? -->
(Proof of eligibility will be required if hired.)
Position Information:
Position applied for:
Employment desired:
Days/hours available to work: (check all that apply)
Mon
to
Tue
to
Wed
to
Thu
to
Fri
to
Sat
to
Sun
to
How many hours can you work weekly? -->
When are you available to start work? (mm/dd/yyyy)
Education:
High School
Name of school:
Location: (complete address)
Years Completed
Major or Degree
College
Name of school:
Location: (complete address)
Years Completed
Major or Degree
Bus or Trade School
Name of school:
Location: (complete address)
Years Completed
Major or Degree
Judicial Information:
Have you ever been convicted of a crime, excluding minor traffic offenses? -->
(A conviction record will not necessarily disqualify you from employment).
If YES, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed and type(s) of rehabilitation. If NO, type "NA" in this box. This box cannot be left blank.
Driver Information:
Do you have a drivers license?
If Yes, Drivers License number:
State:
Expiration (mm/dd/yyyy)
Drivers license type:
No License
Operator
Commercial (CDL)
Chauffeur
Have you had any accidents during the past three years?
If Yes, how many?
Have you had any moving violations during the past three years?
If Yes, how many?
Office Experience:
(Fill out this section ONLY if you are applying for an OFFICE position)
Select all that apply:
Typing (Typewriter, not PC)
If selected, WPM
Computer experience:
If selected:
PC
Mac
Word processing (PC, not typewriter)
If selected, WPM
10 - Key
List any other office skills:
References:
Please list two references other than relatives.
Name:
Position:
Company:
Address:
Address2
Telephone
Name:
Position:
Company:
Address:
Address2
Telephone
Military Information:
Have you ever been in the armed forces?
Are you now a member of the National Guard?
Specialty:
Date Entered: (mm/dd/yyyy)
Discharge Date: (mm/dd/yyyy)
Work Experience:
List your work experience for the past seven years. If you were self-employed, give firm name.
Job #1: (most recent)
Name of employer:
Address:
Address2
City
State
ZIP
Your last job title:
Name of last supervisor:
Employment date:
From: (mm/dd/yyyy)
To: (mm/dd/yyyy)
(leave blank if current)
Pay or salary:
Start: ($ X.XX)
/HR
/Month
/YR
Final: ($ X.XX)
/HR
/Month
/YR
Reason for leaving. (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Job #2:
Name of employer:
Address:
Address2
City
State
ZIP
Your last job title:
Name of last supervisor:
Employment date:
From: (mm/dd/yyyy)
To: (mm/dd/yyyy)
(leave blank if current)
Pay or salary
Start: ($ X.XX)
/HR
/Month
/YR
Final: ($ X.XX)
/HR
/Month
/YR
Reason for leaving. (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Job #3:
Name of employer:
Address:
Address2
City
State
ZIP
Your last job title:
Name of last supervisor:
Employment date:
From: (mm/dd/yyyy)
To: (mm/dd/yyyy)
(leave blank if current)
Pay or salary
Start: ($ X.XX)
/HR
/Month
/YR
Final: ($ X.XX)
/HR
/Month
/YR
Reason for leaving. (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Job #4:
Name of employer:
Address:
Address2
City
State
ZIP
Your last job title:
Name of last supervisor:
Employment date:
From: (mm/dd/yyyy)
To: (mm/dd/yyyy)
(leave blank if current)
Pay or salary
Start: ($ X.XX)
/HR
/Month
/YR
Final: ($ X.XX)
/HR
/Month
/YR
Reason for leaving. (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Work Experience - Continued:
Please use this space to elaborate on any background, experience, or qualifications that you believe should be considered in evaluating your qualifications for employment.  You may include hobbies, volunteer experience and any other activities you believe relevant.  Please omit any information that would disclose your race, gender, age, marital status, ethnic origin, religious or political affiliations, or disability.
May we contact your present employer?
Did you complete this application yourself?
If not, who did?
Are you are able to perform the essential functions of the job for which you have applied:
If you answered No , please identify those job functions that you cannot perform.  If a reasonable accommodation is required to enable you to perform the job properly and safely, please describe:
PLEASE READ CAREFULLY
APPLICATION FORM WAIVER
As indication that you have read and understood each sentence, enter your initials in the boxes provided below.
In exchange for the consideration of my job application by Speedemissions, Inc., (hereinafter called the Company), I agree that: Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment,
or to confer any right to remain an employee of Speedemissions, Inc., or otherwise to change in any respect the employment-at-will relationship between it and the undersigned,
and that relationship cannot be altered except by a written instrument signed by the Owner/Managing Member of the Company.
Both the undersigned and Speedemissions, Inc. may end the employment relationship at any time, without specified notice or reason.
If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.
I authorize investigation of all statements contained in this application.
I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice.
I hereby give the Company permission to contact schools, all previous employers (unless otherwise indicated), references and others and hereby release the Company from any liability as a result of such contact.
I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics and mode of living.
Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.
I further understand that my employment with the Company shall be probationary for a period of ninety (90) days and further that at any time during the probationary period or thereafter, my employment relationship with the Company is terminable at will for any reason by either party.
Signature of applicant
Date
Speedemissions, Inc is an equal employment opportunity employer.  We adhere to a policy of making employment decisions without regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age or disability.  We assure you that your opportunity for employment with Speedemissions, Inc depends solely on your qualifications.

Thank you for completing this application form and for your interest in our business.