Employment Opportunities

Name

First Last

Date

Phone

Present Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How Long Have You Been There?

Are You 18 or Older?

Yes

Date of Birth

Position Applied For

Days Available to Work

Hours available to work each day (please specify if they vary)

How many hours can you work weekly?

Can you work nights?

Yes

Employment Desired

Full Time Only

Part Time Only

Full or Part Time

When are you available for work?

Name of High School

High School Location

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of years completed

Major and Degree

Name of College

College Location

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of years completed

Major and Degree

Bus or Trade School

Bus or Trade School Location

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of years completed

Major and Degree

Professional School

Professional School Location

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of years completed

Major and Degree

Have you ever been convicted of a crime?

Do you have a driver's license?

What is your means of transportation to work?

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

Other skills

References

Name

First Last

Position

Company

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Name

First Last

Position

Company

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Additional Information

An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position which you are applying (please do not mention sensitive information)

Military

Have you ever been in the armed forces?

Yes

Are you now a member of the national guard?

Yes

Date Entered

Discharge Date

Work Experience

Name of Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Name of last supervisor

Start Date

End Date

Start Pay or Salary

Final Pay or Salary

Previous Job Title

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

Name of last supervisor

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Name of Employer

Start Date

End Date

Start Pay or Salary

Final Pay or Salary

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

Name of Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Name of Employer

Start Date

End Date

Start Pay or Salary

Final Pay or Salary

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company

May we contact your present employer?

Yes

Did you complete this application yourself?

Yes

CAPTCHA

Cummins Authorized Dealer

Fax - Fax: (810) 660-7415
Hours: Monday-Friday 7:30am-4:00pm

Give Us a Call! (810) 614-4668

2195 Imlay City Road, Lapeer, MI 48446 (810) 614-4668