Location You Are Applying For*- Select Location -Chicago NorthChicago SouthChicagoland SuburbsName First Last Email Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneEmergency Contact & Phone Education; Highest Grade Completed (1-16, GED) School Name and Year Completed Position Desired Mon-Fri 7:30am-5pm, Sat 9am-2pm, Sun 10am-3pm I have open availability and can work any of the above hours. Yes No If No, Please let us know what your availability is. Type of Work Full Time Part Time Any Have You Ever Been Dismissed From A Previous Employment?YesNoIf Yes, Why, When and Where? Most Recent Employer. Include Employer Name, Employer Phone Number, Start/End Date, Reason for Leaving, Start/End Pay, Managers NameLongest Place of Employment. Include Employer Name, Employer Phone Number, Start/End Date, Reason for Leaving, Start/End Pay, Managers NameDo You Have a Valid Drivers LicenseYesNoUntitled CERTIFICATION I CERTIFY THAT ALL STATEMENTS MADE IN THIS APPLICATION ARE TRUE AND COMPLETE AND AUTHORIZE AARON AUTO GLASS TO INVESTIGATE ALL STATEMENTS MADE FROM ALL PRIOR EMPLOYERS, REFERENCES, CREDIT REPORTING, LAW ENFORCEMENT AND REGULATORY AGENCIES. I HEREBY RELEASE ALL THOSE PERSONS, EMPLOYERS, REFERENCES AND AARON AUTO GLASS FROM ANY AND ALL LIABILITY ARISING FROM THEIR GIVING OR RECEIVING INFORMATION ABOUT MY EMPLOYMENT HISTORY, QUALIFICATIONS AND CREDIT OR CRIMINAL RECORDS. I UNDERSTAND THAT ANY FALSE ANSWERS OR STATEMENTS OR MISREPRESENTATION BY OMISSION MADE BY ME AS PART OF MY APPLICATION, WILL BE SUFFICIENT FOR REJECTION OF MY APPLICATION OR FOR MY IMMEDIATE DISCHARGE SHOULD ONE BE DISCOVERED AFTER I AM EMPLOYED. I UNDERSTAND AARON AUTO GLASS HAS A VITAL INTEREST MAINTAINING SAFE, HEALTHFUL AND EFFICIENT WORKING CONDITIONS AND PREMISES FOR ITS EMPLOYEES AND CUSTOMERS. ILLEGAL DRUGS POSE A SERIOUS THREAT TO THE HEALTH AND SAFETY OF THE USER AND TO OTHERS. I UNDERSTAND EMPLOYEES MUST SUBMIT TO A DRUG SCREENING TEST WHEN REASONABLE CAUSE EXISTS TO BELIEVE AN EMPLOYEE MAY BE USING OR UNDER THE INFLUENCE OF DRUGS OR ALCOHOL I UNDERSTAND THAT IF POSITIVE TEST RESULTS ARE CAUSED BY DRUGS THAT ARE NOT PART OF A CURRENTLY PRESCRIBED MEDICAL TREATMENT PROGRAM , OR IF I REFUSE TO SIGN THIS CERTIFICATION OR COOPERATE FULLY IN THE SPECIMEN COLLECTION PROCESS , I WILL NOT BE HIRED, OR IF AN EMPLOYEE, WILL BE SUBJECT TO DISCIPLINE UP TO AND INCLUDING TERMINATION. I UNDERSTAND THAT NOTHING IN THIS EMPLOYMENT APPLICATION, IN AARON AUTO GLASS STATEMENTS OF PERSONNEL POLICIES OR IN MY COMMUNICATION WITH ANY EMPLOYEE OR OFFICIAL, IS INTENDED TO CREATE AN EMPLOYMENT CONTRACT BETWEEN AARON AUTO GLASS AND ME, THAT MY EMPLOYMENT WITH THE COMPANY IS ENTERED VOLUNTARILY, AND THAT I MAY RESIGN AT ANY TIME. SIMILARLY, MY EMPLOYMENT MAY BE TERMINATED WITH OR WITHOUT CAUSE AT ANY TIME PRIOR NOTICE. Yes No E-Signature Date MM slash DD slash YYYY