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APPLICATION FOR EMPLOYMENT
Saturn of Rochester
770 Panorama Trail
Rochester, New York 14625
Saturn of West Ridge
4692 Ridge Road West
Spencerport, NY 14559
 
Equal access to programs, services and employment is available to all persons. Those applicants who require reasonable accomodation to the application and/or interview process should notify a representative of the Human Resources Department.
 
* indicates required fields      
Desired Position(s):* Date Available to Start:*
     Enter as :mm/dd/yyyy
Desired Type of Employment:* Referral Source:*
   
Your Information:
E-Mail*:
First Name, Middle Initial*:   Last Name*:  
Cell Phone*:   Home Phone*:  
Best time to contact you?*  Morning   Afternoon   Night          
Work Phone*:   Ext: 
May we contact you at work?*   YES   NO
Current Address: 
Address*:
City*: State*: Zip*:
Answer the following:   
If you are under 18, and it is required, can you furnish a work permit?*:      YES   NO   N/A
If No, please explain:   
Have you ever submitted an application here before?*:      YES   NO
If yes, give dates: FROM /TO:   
Have you ever been employed here before?*:      YES   NO
If yes, give dates: FROM /TO:   
Are you legally eligible for employment in this country?*:      YES   NO
Are you able to meet the attendance requirements of the position?*:      YES   NO
Will you work overtime if required?*:      YES   NO
If No, please explain:   
If the job requires it, will you relocate?*:      YES   NO
If the job requires it, will you travel?*:      YES   NO
Have you ever been bonded?*:      YES   NO
Have you been convicted of a crime in the past seven years?*:      YES   NO
If Yes, please explain:   
Employment History:*  
 
Employer 1 Job Title Dates Employed


From To
 
Brief summary of work performed and job responsibilities Starting Hourly Rate / Salary
 
$ Per/
 
Employer's Address Employers Phone Number Final Hourly Rate / Salary
 
 
$ Per/
 
Immediate Supervisor Job Title May we contact for reference?
  YES   NO
Reason for leaving
 
Employer 2 Job Title Dates Employed


From To
 
Brief summary of work performed and job responsibilities Starting Hourly Rate / Salary
 
$ Per/
 
Employer's Address Employers Phone Number Final Hourly Rate / Salary
 
 
$ Per/
 
Immediate Supervisor Job Title May we contact for reference?
  YES   NO
Reason for leaving
 
Employer 3 Job Title Dates Employed


From To
 
Brief summary of work performed and job responsibilities Starting Hourly Rate / Salary
 
$ Per/
 
Employer's Address Employers Phone Number Final Hourly Rate / Salary
 
 
$ Per/
 
Immediate Supervisor Job Title May we contact for reference?
  YES   NO
Reason for leaving
 
Employer 4 Job Title Dates Employed


From To
 
Brief summary of work performed and job responsibilities Starting Hourly Rate / Salary
 
$ Per/
 
Employer's Address Employers Phone Number Final Hourly Rate / Salary
 
 
$ Per/
 
Immediate Supervisor Job Title May we contact for reference?
  YES   NO
Reason for leaving
 
 
COMMENTS: (including explanation of gaps in employment.)
SKILLS AND QUALIFICATIONS: (Briefly summarize any special training, skills, licenses, and/or certificates relative to the position.)
EDUCATIONAL BACKGROUND: (If job related, please list three schools starting with the most recent.)
 
SCHOOL NAME NUMBER OF YEARS
COMPLETED
MAJOR GRADUATED
  YES   NO
  YES   NO
  YES   NO
REFERENCES:*  (Please list the names and phone numbers of three business/work, school, or personal references
who are NOT related to you and are not previous supervisors.)
 
NAME PHONE NUMBER YEARS KNOWN
I grant Saturn of Rochester the right to contact all references, employers, and educational institutions to obtain information and to verify the accuracy of information contained in this application.

I hereby release Saturn of Rochester and its representatives from any liability for seeking,  gathering and using such information. Likewise, all other persons, corporations or organizations shall not be held liable for furnishing such information.

New applications are regarded as current for only 60 days. At the end of this time, if I still wish to be considered for employment I understand that it is my responsibility to submit a new application.

Saturn of Rochester does NOT discriminate in employment, and no question on this application is designed for limiting or excusing any applicant from consideration on a basis prohibited by local, state or federal law.

I understand that Saturn of Rochester will NOT refuse to hire a qualified individual with a disability, as the ADA requires reasonable accommodation for such individuals.

This application is not a contract for employment.

If I am hired, I understand that I am free to resign at any time, with or without cause, and without prior notice. Equally, Saturn of Rochester reserves the same right to terminate employment, at any time, with or without cause, and without prior notice, except as may be required by law.

MOTOR VEHICLE RECORD REVIEW DISCLOSURE
As part of the employment process. Saturn of Rochester/West Ridge may procure a report of your Motor Vehicle Record/ Drivers License Record from Softech or a similar provider of driving information. Upon request, you will be informed: (1) whether or not such a report is requested, and (2) if such a report was requested you will be informed of the name and address of the agency furnishing the report. Saturn of Rochester/West Ridge may procure and use this report upon my conditional hiring and every six months thereafter should obtain employment with Saturn of Rochester/West Ridge.  After the commencement of employment, citations totaling more than 6 points will lead to revocation of driving privileges of company vehicles or personal vehicles on company business. Understand that in many instances, revocation of driving privileges will lead to termination. Accumulation of 4 or more points will lead to a six-month probation period. During this period, any citations received by the driver will lead to his/her driving privileges revoked. A driver may be placed on probation twice. The accumulation of 6 or more points following 2 probation periods will lead to the immediate revocation of driving privileges and likely termination.


I hereby authorize Saturn of Rochester/West Ridge to procure a report of my Motor Vehicle Record/ Drivers License Record from Softech or a similar provider record information. Saturn of Rochester may use this information for employment purposes only. I understand and agree that Saturn of Rochester/West Ridge may procure and use this report upon my conditional hiring and every six months thereafter should I obtain employment with Saturn of Rochester/West Ridge.

I understand that if I am employed, any misrepresentation or omission that I have made on this application, whenever it is discovered, will be sufficient cause for cancellation of this application, and/or immediate termination from Saturn of Rochester’s service.

Finally, if I am hired, I am willing to provide proof of identity and legal work authorization.


By signing below, I confirm I have read, fully understand the above passage, and seek employment under these conditions.
Type Signature *   Date *:                  
 
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Saturn of Rochester -- 770 Panorama Trail, Rochester NY   (585) 586-6959   ●   Saturn of West Ridge -- 4692 Ridge Road West, Spencerport, NY (585) 352-5995
 
 
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