Contact RepairSelect.com Please complete the form below and a representative will contact you as soon as possible. Applicant Information Name Social Security Number Email Phone Address City State Zip How did you hear about us? Military Service Military Branch Date Entered Discharge Date Rank at Discharge If discharge is other than honorable please explain: Employment Desired Position Date Available to Start Are You a Citizen of the United States? YES NO If No, Can You Provide Proof of Work Eligability? YES NO Have You Worked For Us before? YES NO If Yes, Please Explain (Include Dates) Have You Ever Been Convicted of a Felony? YES NO If Yes, Please Explain (Include Dates) Education High School Did You Graduate? YES NO Major College Did You Graduate? YES NO Major Technical / Trade School Did You Graduate? YES Major Other Education Did You Graduate? YES NO Major List any Auto Body Repair Certifications. Employment Previous Experience Company Name Address / Location Phone Supervisor Name Job Title Responsibilities Dates Employed From TO Salary / Wages Start End Reason for Leaving May We Contact Employer? YES NO Other Previous Experience Company Name Address / Location Phone Supervisor Name Job Title Responsibilities Dates Employed From TO Salary / Wages Start End Reason for Leaving May We Contact Employer? YES NO Comments Additional Comments Application Waiver I certify that my answers are true and correct. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. This company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications. Thank you for completing this application form and for your interest in our business. Spam Filter Please Enter The Words Below In order to avoid unwanted spam, please enter the text you see below. If you cannot read the text, use the refresh icon below the text to select new text.