Employment Application
CHAINWHEEL DRIVE, INC.
EMPLOYMENT APPLICATION
Personal Information:
Name ____________________________________________________ Date ______________
Present address _______________________________ City_____________State____Zip_____
Previous address ______________________________ City _____________State____Zip_____
How long at current address? ______________How long at previous address? ______________
Home phone number ___________________ Cell phone number ___________________
Email address _______________________________
Marital status: Single____ Married ____ Are you 18 years of age or older? Yes ____ No ______
Are you legally eligible for employment in the United States? Yes ____ No ____
Have you ever been charged with or convicted of a crime in any state (including felonies, misdemeanors, guilty pleas, or pleas of nolo contendre) other than minor traffic offenses?______
If yes, please explain______________________________________________________________
Note: Applicants may be subject to a background check. A prior charge or conviction
will not necessarily bar you from employment; however, the type of conviction
and when it occurred will be considered.
If hired, would you be able to perform all functions and all necessary job assignments of the particular job for which you are applying? Yes ____ No ____ If no, please explain
____________________________________________________________________________
Have you ever received workmen's compensation or disability income payments? Yes___No___
If yes, please describe___________________________________________________________
How did you learn of our organization? ______________________________________________
What interest or background in cycling do you have (activities, competition, home repair, etc.)?
_____________________________________________________________________________
Employment Interest:
Sales/merchandising ____ Technician ____ Assembler ____ Inventory control/purchasing ____
Bookkeeping ____ Office Assistant ____
Date available to start ____________ Pay/wages desired ____________________
Are you employed now? ______ If yes, may we contact your present employer? _______
If no, please explain ____________________________________________________________
Have you ever applied to Chainwheel Drive before? Yes ____ No ____
Which location? ______________ When? _______________
Please indicate hours you can work. If no limitations, list all.
Mon ______ Tues ______ Wed ______ Thur ______ Fri ______ Sat _______ Sun _______
Number of hours you wish to work per week: _________________
Education: | ||||
Name and Location of School | Subjects Studied/ Degree | Did you graduate? | # Years Attended | |
Elementary School | ||||
High School | ||||
College | ||||
Trade or Business | ||||
Military Service: Complete this section if you served in the U.S. Armed Forces. | ||||
Describe your duties and any special training______________________________________________ | ||||
___________________________________________________________________________________ | ||||
Branch of service________________________ Rank at discharge_____________________________ | ||||
Period of active duty (Month & Year): From ____________ To _______________ | ||||
Date of discharge _____________________________ | ||||
Present membership in National Guard or Reserves ________________________________________ | ||||
Employment History: | ||||
Please list your full-time and part-time employment record for your past four positions, starting with | ||||
your present or most recent employer and account for any periods of unemployment. Use a | ||||
separate sheet, if necessary. | ||||
Company Name | Telephone | |||
Address | Dates Employed:From _______ To _______ | |||
Name of Supervisor | Weekly Pay: Start ________ Last _________ | |||
State Job Title and Describe Your Work | Reason for leaving | |||
Company Name | Telephone | |||
Address | Dates Employed:From _______ To ________ | |||
Name of Supervisor | Weekly Pay: Start ________ Last _________ | |||
State Job Title and Describe Your Work | Reason for leaving | |||
Company Name | Telephone | |||
Address | Dates Employed:From _______ To _______ | |||
Name of Supervisor | Weekly Pay: Start ________ Last ________ | |||
State Job Title and Describe Your Work | Reason for leaving | |||
Company Name | Telephone | |||
Address | Dates Employed:From _______ To _______ | |||
Name of Supervisor | Weekly Pay: Start ________ Last ________ | |||
State Job Title and Describe Your Work | Reason for leaving | |||
Except for vacations and holidays, how many work days were you absent during the past calendar
year? 0-5 days____ 6-10 days ____ 11-15 days ____ 16-20 days ____ 21+ days ____
References: Give the names of three persons not related to you, whom you have known at least
one year.
Name Address Relationship to you Phone Years
Acqainted
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Service Department Supplement:
(Service applicants only)
Please indicate your ability to perform the following tasks, WITHOUT SUPERVISION OR ASSISTANCE.
Answer the questions with a yes or no answer.
Can you adjust: Headsets? ______ Hubs? ______ Bottom brackets? ______
Can you overhaul: Headsets? ______ Hubs? ______ Bottom brackets? ______
Can you install tires and tubes? ______ Can you install tubular tires? ______
Can you size and install A chain? ______ Do you know how to check A chain for wear? ______
Do you know how to adjust the limit screws on derailleurs? ______
Can you install road bike brake lever/shifters (STI,Ergo) ? ______
Can you true wheels? ______ Can you build wheels? _______
Can you replace spokes and find the proper length? ______
Can you overhaul spring/elastomer suspension forks? ______
Can you overhaul air/oil suspension forks? ______
CERTIFICATION: (All applicants)
I hereby authorize the release of any employment data relevant to my employment with Chainwheel Drive, Inc. for the
purpose of a bonafide credit and employment investigation. I authorize a thorough investigation of my past employment
activities, and background and agree to cooperate in such investigation, and release from all liability or responsibility all
persons and corporations requesting or supplying such information. This investigation shall also include a determination
regarding whether I have a criminal record.
I fully understand that if employed, any misrepresentation or omission on this application will result in dismissal,
regardless of the date of discovery. Employment may also be subject to my passing a medical examination as required
by the Personnel policies of Chainwheel Drive, Inc. and to a satisfactory review of my references.
I understand that neither the Application nor any statement made to me during the hiring process or thereafter shall be
considered a contract of employment of any kind. Where such a contract is intended, I understand that it will be
separately entered into and signed by the President of the Company.
Signature: _______________________________________ Date: ____________________