Name* First Last Address* Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Applying for the position ofInstallerWelderPaint PolishDetailerEngineerFront Office PositionMechanicOthersSpecify Other Position How did you hear about us? Salary Requirement Employment Desired*Full-TimePart-TimeDriver PositionI am a US Citizen or National of the US, an alien lawfully working for permanent residence, or an alien authorized to work in the US for PL Custom Body.* Yes No If no, are you authorized to work in the U.S.?* Yes No Is English your first language?* Yes No Please rate your level of English* 9 - Very Advanced = I speak and understand English completely fluently. 8 - Advanced = I speak and understand very well but sometimes have problems with unfamiliar situations and vocabulary. 7 - Pre-Advanced = I speak and understand well but still make mistakes and fail to make myself understood occasionally. 6 - Upper Intermediate = I speak and understand well but still make mistakes and fail to make myself understood occasionally. 5 - Intermediate = I can speak and understand reasonably well and can use basic tenses but have problems with more complex grammar and vocabulary. 4 - Low Intermediate = I can make simple sentences and can understand the main points of a conversation but need much more vocabulary. 3 - Pre-Intermediate = I can communicate simply and understand in familiar situations but only with some difficulty. 2 - Elementary = I can say and understand a few things in English. 1 - Beginner = I do not speak any English. If the position requires driving, do you have a valid driver’s license?* Yes No Did you receive any discipline in your last 12 months of active employment? Yes No If you answered yes, please explain:Have you ever been discharged or asked to resign from employment? Yes No Were you given a performance evaluation within the last 12 months of active employment? Yes No Are you able to perform the “essential functions” of the job for which you are applying? Yes No This question is not designed to elicit information about a disability. Please do not provide information about the existence of a disability, particular accommodation or whether an accommodation is necessary. These issues may be addressed later to the extent permissible by law.EducationPlease indicate your highest level of education.*Some High SchoolHigh School / GEDVocational / Trade SchoolSome CollegeAssociate's DegreeBachelor's DegreeMaster's DegreeDoctorate DegreePlease indicate field of study High School / College / University Name Diploma / Degree Name Graduation Year19401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016ReferencesPlease list three professional references.Reference 1* First Last Relationship* Company Phone*Reference 2* First Last Relationship* Company Phone*Work ExperienceAre you currently employed?* Yes No Most Recent Employer* Job Title Date Started* MM slash DD slash YYYY Date Ended MM slash DD slash YYYY Supervisor PhoneStarting pay Final pay Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reason for Leaving: May we contact your previous supervisor for a reference? Yes No Previous Employment Job Title Date Started MM slash DD slash YYYY Date Ended MM slash DD slash YYYY Supervisor PhoneStarting pay Final pay Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reason for Leaving: May we contact your previous supervisor for a reference? Yes No Skills and QualificationPlease enter any additional information or notes.Upload your resume and letter of recommendation here.Max. file size: 200 MB.* I hereby certify that all of the information provided by me in this application (or any other enclosed or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery. I understand that submission of an application does not guarantee employment. I further understand that such employment with PL Custom Body is at will, for no specified duration; and may be terminated by either PL Custom Body or me at any time, with or without cause. I understand that none of the documents, policies, procedures, actions or statements of PL Custom Body or its representatives used during the employment process is deemed a contract of employment, real or implied. I understand that no representative of PL Custom Body, except the President, has the authority to enter into any agreement guaranteeing any conditions of employment or any agreement contrary to the foregoing statements; and that any such agreements must be made in writing and signed by the President of PL Custom Body. In consideration for employment with PL Custom Body if employed, I agree to conform to the rules, regulations, policies and procedures of PL Custom Body at all times and understand that such obedience is a condition of employment. I understand that if offered a position with PL Custom Body, I may be required to submit to a pre-employment medical examination, drug screening, background check, and/or credit check as a condition of employment. I understand that unsatisfactory result from, refusal to cooperate with, or any attempt to affect the results of these pre-employment tests and checks will result in withdrawal of any employment offer or termination of employment if already employed. I hereby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to PL Custom Body and/or any of its representatives, agents or vendors; and I release any and all parties involved from all liability for any damage that may result from providing such information. I understand that this application is considered current for six months. If I wish to be considered for employment after six months from completion of this application form, I will need to complete a new application form. By signing below, I acknowledge that I have read, understand and agree to the above statements. 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