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Full Name*

First Middle Last

Phone*

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Position Applied for*

What position(s) are you applying for?

Date Available*

When can you start?

Desired Salary*

What is your desired annual salary?

Social Security Number*

Last 4 digits only.

Are you legally authorized to work within the United States?*

Yes
No

Have you ever worked for this company?*

Yes
No

Do you have any relatives working at the same yard/site as that applied?*

Yes
No

Name of Relative/Relation

Education

High School*

Diploma*

High School Address*

City State

College

Degree

College Address

City State

Did you graduate College?

Yes
No

Other Education

Recent Employment

Company

Phone

Address

City State

Job Title

Supervisor

Responsibilities

Starting Salary

Ending Salary

From

When did you start?

To

When did you leave?

Reason for Leaving

May we contact this employer?

Yes
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Other Previous Employment

Company

Phone

Address

City State

Job Title

Supervisor

Responsibilities

Starting Salary

Ending Salary

From

When did you start?

To

When did you leave?

Reason for Leaving

May we contact this employer?

Yes
No

Other Employment

Any other additional employment you'd like to mention?

Military Service

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To

Branch

Rank at Discharge

References

Please list three professional references (not a relative).

Full Name (1st Reference)*

First Last

Relationship (1st Reference)*

Company (1st Reference)

Phone (1st Reference)*

Address (1st Reference)*

Full Name (2nd Reference)*

First Last

Relationship (2nd Reference)*

Company (2nd Reference)

Phone (2nd Reference)*

Address (2nd Reference)*

Full Name (3rd Reference)*

First Last

Relationship (3rd Reference)*

Company (3rd Reference)

Phone (3rd Reference)*

Address (3rd Reference)*

Disclaimer

I hereby certify that the facts set forth in the above employment application and all other information/documents I have provided are true and complete to the best of my knowledge and authorize Fenix Parts, Inc. to verify their accuracy and to obtain reference information on my work performance. I hereby release Fenix Parts, Inc. from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information.

I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application, or on any other information submitted in the hiring process, shall be considered sufficient basis for dismissal. I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of the Employer. However, I further understand that neither the policies, rules, regulations of employment or anything said during the interview process shall be deemed to constitute the terms of an implied employment contract.

I understand that any employment offered is for an indefinite duration and at will and that either I or the Employer may terminate my employment at any time with or without notice or cause.

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I understand and agree with the Disclaimer

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