Employment Application

Please fill out our employment application and click "Send Information" at the bottom of this page. If you have any questions, call 757-867-8585.

Personal Information * required field 
* Name:
* Address:
* City:
* State:
* Zip:
* Phone:
Cell:
Pager:
Work:
* Email:
Salary Requirements $:
Are you 18 years or older?  yes  no
Are you 21 years or older?  yes  no
Are you legally able to work in the US?  yes  no
   Note: You will be required to show this after hire on a 1-9 form.
If the position requires driving a car,
  do you have a current VALID
  driver's license?		  yes  no
Have you ever been convicted of a
  misdemeanor or felony?		  yes  no
Please describe any convictions:
Employment Desired  
Position:
Date You Can Start:
I desire to work:
I prefer to work what shift?
What hours can you work?
 Monday   Tuesday 
 Wednesday   Thursday 
 Friday   Saturday 
 Sunday 
Are you employed now?  yes  no
If yes, may we inquire of
  your current employer?		  yes  no
Do you plan to work another job?  yes  no
If yes, what hours?
Transportation  
I have reliable transportation to:
  		  yes  no
Education  
Grammar School...
  Name:
  Location:
  # of Years:
  Graduated:  yes  no
  Degree Name:
High School...
  Name:
  Location:
  # of Years:
  Graduated:  yes  no
  Degree Name:
College...
  Name:
  Location:
  # of Years:
  Graduated:  yes  no
  Degree Name:
Other School...
  Name:
  Location:
  # of Years:
  Graduated:  yes  no
  Degree Name:
Military Service  
U.S. Military?  yes  no
National Guard?  yes  no
Branch:
Rank:
Active Now?  yes  no
Position Title or Summary:
Employment History  
List your last three (3) employers, assignments or volunteer activities, starting with the most recent, including military experience. Explain any gaps in employment in the comments section below.
Employer:
Address:
Dates Employed:
Job Title:
Hourly Rate/Salary $:
Supervisor Name:
Phone:
Summarize Duties:
Reason for Leaving:
Employer:
Address:
Dates Employed:
Job Title:
Hourly Rate/Salary $:
Supervisor Name:
Phone:
Summarize Duties:
Reason for Leaving:
Employer:
Address:
Dates Employed:
Job Title:
Hourly Rate/Salary $:
Supervisor Name:
Phone:
Summarize Duties:
Reason for Leaving:
Comments, including explanation
  of gaps of employment:
Please Read Below Carefully Before Submitting...  
By clicking "Send" below, I certify that all the information submitted by me on this application is true and complete. I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected, and, if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company's rules, regulations and Supervisor's directions. I agree that my employment is at-will, and that my employment and compensation can be terminated, with or without cause, and with or without notice, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than the president, and then only in writing, has any authority to enter into any agreement for employment for any specific period of time or to make any agreement contrary to the forgoing. I further authorize all work related verifications of employment, education, training or other work related information, as well as credit or criminal records checking. I authorize all of this information to be provided to Danny's Auto Glass and Mirror or their agent and release them from any liability which might be claimed. I agree to complete and fully participate in a drug test; if requested.