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Contact Information
First Name:Eric
Last Name:Mercurio
MI:D
Social Security No:1234212332
Street Address123 Main Street
Telephone Number(215) 515-5448
CityWest Chester
StatePA
Zip Code19380
Emergency Contact
Name:Sally Mercurio
Relation:Wife
Telephone Number:(215) 525-5115
How did you hear about Conestoga Collision Career Opportunities?Employee Referral
Employee Name:Bill
Were you previously employed by Conestoga Collision?No
Preferences
Position Applying For:Body Tech
Type of Employment Desired:Permanent,
Full-Time
Desired Salary:48000
Available to Start Working:06/25/2020
Employee Eligibility
Are you of legal age to work in the United States?Yes
Background InformationA criminal record will not automatically disqualify you from the job from which you are applying.
Do you have a valid driver’s license?Yes
Have you ever been convicted of a felony?Yes
If yes, for what have you been convicted, when, and where?

I did a bad thing

Education(Use the +button to the right to add multiple entries for this section.)
School Name & Location Start Date End Date Course of Study Did you graduate? Diploma/Degree
Cat Pickering Phoenixville Auto Jan 2012 Dec 2015 Yes Yes
Employment HistoryPlease list your employment history starting with the most recent. (Use the +button to the right to add multiple entries for this section.)
Company Name Telephone Number Address Job Title Starting Salary Ending Salary Dates Employed Job Responsibilities Supervisor Name May we contact your old supervisor? Reason for Leaving
Jim's Berwyn 6106885655 Berwyn Master Tech 40000 45000 Jan 05 - Feb 2010 Being good at my job JR Sure Money
Are there any other experiences, skills, or qualifications which you feel would especially qualify you for work at Conestoga Collision? (Example: procedure and/or estimating experience, ICAR or manufacturer certifications, etc.)

I am a team player who loves to learn

Why do you want to work for Conestoga Collision?

I am read for a challenge

Explain how you feel you could be a benefit to Conestoga Collision.

I have tremendous skills and work well in a group

References:(Use the +button to the right to add multiple entries for this section.)
Business/Professional References
Name, Occupation and Company Address Phone Number
Jim, VP, Jim's Auto 123 Main St., Media PA 2156669958
Bill, VP, Bill's Auto 123 Second St., Media PA 2156769958
Personal References
Name, Occupation and Company Address Phone Number
Melissa, Pres, ABC Towing 12 Front St., West Chester 6105559988
Applicant’s StatementPlease read before signing
Signature
Date06/09/2020

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