Dan Dipert Companies

Application for Employment

Position:

Please complete the form below to complete a job application.

First Name:
Last Name:
Middle Name:
Social Security:
How did you hear about
this employment opportunity?
Phone:
Mobile / Other:
Email:
Street Address:
City:
State:
Zip:
If necessary, best time to call you at home?
May we contact you at work?
If yes, work number and best time to call:




If you are under 18, and it is required, can you furnish a work permit?
If no, explain


Are you eligible for employment in the United States of America?
Date available for work:

(mm-dd-yy)


What is your Desired Salary:
Type of Employment desired:

Will you relocate if job requires?
Will you travel if the job requires?
Are you able to meet the attendance requirements of the position?
Will you work overtime if required?
If no please explain:
Have you ever been bonded?
Have you ever pled "guity" to, or been convicted of a crime?
Do you smoke?

Employment History (Most Recent)

Starting with your most recent employer, assignments or volunteer activity, provide the following information.

Employer (most recent):
Phone Number:
Dates Employed:
Street Address:
City:
State:
Starting Job Title:
Final Job Title:
Compensation (Starting):



Immediate Supervisor and Title:
Reason for leaving:
May we contact for reference?
Compensation (Final):


Summarize the types of work performed and job responsibilities:

Employer #2

Employer:
Phone Number:
Dates Employed:
Street Address:
City:
State:
Starting Job Title:
Final Job Title:
Compensation (Starting):



Immediate Supervisor and Title:
Reason for leaving:
May we contact for reference?
Compensation (Final):


Summarize the types of work performed and job responsibilities:

Skills and Qualifications

Please check the computer skills you possess:

Summarize any special training, skills, licenses and/or certifications that may qualify you as being able to perform job-related functions in the positino for which you area applying.

Educational Background

Starting with your most recent school attended, provide the following information

School #1(including City and State):
Number of Years Completed:
Acheived:
GPA:
School #2(including City and State):
Number of Years Completed:
Acheived:
GPA:

References

List the names and telephone numbers of three business/work references who are NOT previous supervisors. If not applicable, list three school or personal references who are not related to you.

Reference 1
Name:
Title:
Relationship to Candidate:
Phone:
Number of Years Known:
Reference 2
Name:
Title:
Relationship to Candidate:
Phone:
Number of Years Known:
Reference 3
Name:
Title:
Relationship to Candidate:
Phone:
Number of Years Known:

Additional Information

List professional, trade, business or civic associations and any offices held. Exclude memberships that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any other similarly protected status.

Organization 1
Organization:
Offices Held:
Organization 2
Organization:
Offices Held:

List special accomplishments, publications, awards, etc. Exclude memberships that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any other similarly protected status.

If you have a resume available, please paste it into the box below.

 

Application Statement

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this publication, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that the employer does not unlawfully discriminate in employment and no question in this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it is necessary to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at anytime, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

I understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

Answering "yes" to these questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer's service, whenever it is discovered.

DO NOT AGREE UNTIL YOU HAVE READ THE ABOVE STATEMENT.

I certify that I have read, fully understand and accept
all terms of the foregoing Application Statement.

 

 

 

You may also reach us by phone or mail at:

Dan Dipert Tours, Travel, Vacations, or Coaches
P.O. Box 580 Arlington, Texas 76004-0580
Toll Free: 1-800-433-5335
Phone: 817-543-3700
Fax: 817-543-3728