June 9, 2020

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Contact Information

First Name:

Eric

Last Name:

Mercurio

MI:

D

Social Security No:

1234212332

Street Address

123 Main Street

Telephone Number

(215) 515-5448

City

West Chester

State

PA

Zip Code

19380

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

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Dates of Employment

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 legally eligible for employment in the United States?

Yes

Are you of legal age to work in the United States?

Yes

Background Information

A 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
School
  • Cat Pickering
Name & Location
  • Phoenixville
Start Date
  • Auto
End Date
  • Jan 2012
Course of Study
  • Dec 2015
Did you graduate?
  • Yes
Diploma/Degree
  • Yes
Employment History

Please 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
Company Name
  • Jim's Berwyn
Telephone Number
  • 6106885655
Address
  • Berwyn
Job Title
  • Master Tech
Starting Salary
  • 40000
Ending Salary
  • 45000
Dates Employed
  • Jan 05 - Feb 2010
Job Responsibilities
  • Being good at my job
Supervisor Name
  • JR
May we contact your old supervisor?
  • Sure
Reason for Leaving
  • Money
Skills/Qualifications

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
Name, Occupation and Company
  • Jim, VP, Jim's Auto
  • Bill, VP, Bill's Auto
Address
  • 123 Main St., Media PA
  • 123 Second St., Media PA
Phone Number
  • 2156669958
  • 2156769958
Personal References
Name, Occupation and Company Address Phone Number
Melissa, Pres, ABC Towing 12 Front St., West Chester 6105559988
Name, Occupation and Company
  • Melissa, Pres, ABC Towing
Address
  • 12 Front St., West Chester
Phone Number
  • 6105559988
Applicant’s Statement

Please read before signing

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By signing my name below, I certify that all statements made on this application are true and complete to the best of my knowledge. I have not withheld any information requested on this form.

I authorize Conestoga Collision to contact each of my employers, except those indicated, as well as schools and law enforcement agencies to obtain information needed to consider myself for employment. I understand that misrepresentation or omission of this information can affect the outcome of the decision to be hired or cause termination of employment.

Signature

Date

06/09/2020

Entry Date

June 9, 2020