EMPLOYMENT APPLICATION

Applications are considered without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the existence of a non-job-related medical condition or handicap.

PERSONAL INFORMATION: Date:________________ Position(s) Desired:_________________________________________ Full Time Part Time Temporary

Desired Start Date:_______________

Name (Last, First, Middle Initial) Street Address: City State Zip Code

Telephone Number Social Security Number

Have you ever worked for this company before?

Yes

No

If yes, please give dates and position: ___________________________________________________________ If a drivers license is required for the position for which you are applying, do you have a valid drivers license? Yes No

Referral Source: Walk-in Private Employment Agency Advertisement-Source______________________ Government Employment Agency School

Employee_______________________ Other__________________________

Revised December 2008

Have you ever been convicted of a crime or received a verdict of anything other than not guilty in any criminal investigation or proceedings?: Yes No If yes, describe when the conviction occurred, the facts and circumstances, and any facts pertaining to rehabilitation. (Do not list any criminal charges for which the records have been expunged or sealed. A criminal offense will not necessarily bar employment.): __________________________________________________________________________________________ __________________________________________________________________________________________

EDUCATION: High School School Name Years Completed (circle) Diploma/Degree Describe Course of Study or Major
Describe any Specialized Training, Military Experience, Skills and Extra-Curricular Activities

College/University

Graduate/Professional

10

11

12

EMPLOYMENT/WORK EXPERIENCE: Start with your present or most recent employer. Include military service assignments and volunteer activities. Exclude organization names that indicate race, color, religion, sex or national origin.
Employer: Street Address: Job Title: Supervisor: Phone Number: City State Zip Code Employment Dates (Month, Year): From: Describe Duties/Responsibilities/Accomplishments: To:

Reason For Leaving:

Revised December 2008

EMPLOYMENT/WORK HISTORY CONTINUED:

Employer: Street Address: Job Title: Supervisor: Phone Number: City State Zip Code Employment Dates (Month, Year): From: Describe Duties/Responsibilities/Accomplishments: To:

Reason For Leaving:

Employer: Street Address:

Job Title: Supervisor: Phone Number:

City

State

Zip Code

Employment Dates (Month, Year): From: To:

Describe Duties/Responsibilities/Accomplishments:

Reason For Leaving:

References:
Name: Street Address: City State Zip Code Relationship: How long have you known? Phone Number:

Name: Street Address: City State Zip Code

Relationship: How long have you known? Phone Number:

Name: Street Address: City Revised December 2008 State Zip Code

Relationship: How long have you known? Phone Number:

SPECIAL SKILLS: Describe any special skills or qualifications for this work: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

I CERTIFY that the above answers are true and complete to the best of my knowledge. I authorize Pohanka Automotive Group, to investigate any statement contained in this application. I understand that this application is not and is not intended to be any kind of contract or agreement. In the event of employment, I understand that any false or misleading information given in my application, correspondence, discussions or interview may result in immediate termination. __________________________________________________ Signed
Please do not write below the above line:

__________________________ Date

Interview Notes: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

Interviewed By:________________________________ Dealership:____________________________________

Revised December 2008

Date:____________________________ Department:______________________

APPLICANTS STATEMENT
I understand that this application is not a promise of employment. I understand that if I am hired, my employment will be for no definite period, regardless of the period of payment of wages. I further understand that I have the right to terminate my employment at any time with or without notice of cause and the Company has the same right. No one other than the President of the Company has the authority to modify this relationship or to make any agreement to the contrary. Any such modification or agreement must be in writing and signed by the authorized agent. I consent to take any physical examinations, including, but not limited to, tests for alcohol or drugs, that may be requested by the Company: (1) following an offer of employment and prior to commencement of work; and (2) during the course of my employment, consistent with applicable law, including, but not limited to, the Americans With Disabilities Act. I further authorize any health care professional or testing facility who performs such an examination or who has other information concerning my physical, mental or other medical status to release such information to the Company. I understand that if my drug screen is positive for any illegal substance, that any offer of employment will be rescinded, or if I have already commenced work, I will be terminated. I also understand that I may be required to take other tests, such as personality and honesty tests, prior to my employment and during my employment and that submission to such tests is a condition of employment or continued employment. I hereby authorize the Company to obtain from schools, former and current employers, government agencies or other individuals or institutions it contacts, any information in their possession regarding my employment history or qualifications for the job for which I have applied, my driving record and my criminal record, regardless of whether the information is favorable or unfavorable to me. I promise to hold harmless, covenant not to sue and release the Company, the entities and individuals contacted and their agents from any and all liability which may directly or indirectly result or flow from the obtaining and use, disclosure and/or dissemination of such information. I hereby state that all of the information that I provide on this application and in any interview or in responding to any requests for information is true and accurate. I understand that any false statements or omissions made by me in connection with this application, or in responding to further requests for information, is sufficient grounds for my rejection as an applicant or my dismissal if I have been hired, regardless of when the falsity or omission is discovered. If I am employed and any such information is later found to be false in any respect, I may be dismissed. I HAVE READ THIS EMPLOYMENT APPLICATION AND I FULLY UNDERSTAND ITS CONTENTS

_______________________________________________ Signature of Applicant

_____________________ Date

DECLARACION DEL SOLICITANTE

Entiendo que esta solicitud no es un compromise del empleo. Entiendo que en caso de realizarse una contractacin, mi empleo no tendr duracin definitiva y no se tomar en consideracin el perodo de pago de mis salarios. Entiendo adems que tengo el derecho de renunciar en cualquier momento a mi trabajo sin causa o notifcacon previa y que la empresa tambin goza del mismo derecho. Solamente el Presidente de la compaa est autorizado a modifcar este vnculo o acordar lo contrario. Toda modificacin o acuerdo deber realizarse por escrito y deber estar frmado por un agente autorizado. A peticin de la empresa accedo a someterme a cualquier examen fsico que incluya, pero no se limite a, pruebas de alcohol y drogas: 1) despus de recibida la oferta de trabajo y antes de iniciarse el empleo; y 2) durante el transcurso de mi tabajo, en conformidad con la ley pertinente que incluye pero no se encuentra limitada al decreto Americanos con Incapacitaciones (Americans with Disabilities Act). Autorizo, adems, a cualquier professional medico o laboratorio encargado de ralizar dichas pruebas, o a quien posea informacin referente a mi estado fsico o mental, o de otra naturaleza mdica, a entregar a la empresa la informacin requerida. Entiendo que si el resultado de las pruebas determina el uso de sustancias ilegales, la oferta de empleo quedar anulada, o en caso de haber iniciado mi trabajo, ser despedido. Entiendo, adems, que antes de la conratcin y durante el perodo de empleo puedan requerirse otras pruebas, tales como tests de personalidad y honestidad, y que la entrega de las mismas sera una condicin para la contratacin o continuacin de mi trabajo. Mediante la presente autorizo a la compaa a contactar a las instituciones acadmicas, los empleadores pasados y presentes, las agencies gubernamentales, u otras personas o entidadas, con el fin de obtener informacin concerniente a mi ejecucin professional y a mis capacidades para desempearme en la posicin para la cual estoy solicitando empleo. Autorizo tambin a revisar mi expediente automovilstico y policial aunque la informacin obtenida pueda ser perjudicial para mi persona. Promento no perjudicar ni llevar a juicio, y liberar a compaa, a las personas, las entidades y sus agents de toda responsabilidad por posibles daos que pudieran surgir como resultado directo o indirecto de la obtencin y uso, divulgacin y/o propagacin de dicha informacin. Mediante la presente declare que toda la informacin suministrada en esta solicitud y en toda entrevista realizada o en respuesta a cualquier peticin de informacin adicional es verdadera y correcta. Entiendo que de haber omitido o suministrado informacin falsa en esta solicitud, o en repuesta a peticiones de informacin adicional, la compaa tendra razn suficiente para rechazar mi solicitud de empleo o para despedirme en caso de haberme contratado, sin tomar en consideracin el tiempo transcurrido antes de descubierta la falsedad u omission de informacin. Si en caso de ser contratado se descubriera que la informacin entregada es falsa, podra resultar en mi despido. HE LEIDO ESTA SOLICITUD DE EMPLEO Y ENTIENDO COMPLETAMENTE SU CONTENIDO

_____________________________________________________ Firma del solicitante

___________________________ Fecha

Revised December 2008