BlueRidgeServices
 
 
carrier dealer logo
Call by 2pm – Same Day Service with No Overtime.
 
Call Us: 434-977-7318
1175 5th SW , Charlottesville VA 22902
 
 

 
 
 
 

 

Employment Application

The company is an equal opportunity employer. As such, we provide employment opportunities without regard to race, color, religion, national origin, gender, age, disability, veteran status, military service, or other characteristics protected by law.

Position Sought

Personal Information

 
Are you at least 18 years old?
 
 Yes  No 
 
 
Are you authorized to work in the U.S.?
 
 Yes  No 
 
 
Do you now, or will in the future, require sponsorship for employment visa status:
 
 Yes  No 
 
 
Position Desired
 
 Full-time  Part-time 
 
 
Ex: Morning, Afternoon etc.
 
Ex: Mon, Tues, Wed, etc.
 
Overtime Availability
 
 Yes  No 
 
 
Have you ever worked for this company before
 
 Yes  No 
 
 
If so
 
 
 
 

Education

 
Name and Location
 
 
 
Years Completed
 
 9  10  11  12 
 
 
Did you Graduate?
 
 Yes  No 
 
 
Name and Location
 
 
 
 
Years Completed
 
 Fr  So  Jr  Sr 
 
 
Did you Graduate?
 
 Yes  No 
 
 
Name and Location
 
 
 
 
Did you Graduate?
 
 Yes  No 
 
 
Name and Location
 
 
 
 
Did you Graduate?
 
 Yes  No 
 

References

(List 3. Do not list relatives, domestic partners or former employers.)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Employment History

 
Have you ever been involuntarily termiinated or asked to resign from employment?
 
 Yes  No 
 
Have you ever been counseled, disiplined, terminated or asked to resign as a result of reported workplace harassment, fighting/assault, violation of safety rules, or other inappropriate conduct?
 Yes  No 
List your complete employment history, including military service, starting with your present status. All periods of unemployment must be identified as "Unemployed" and dates of unemployment identified. Do not leave time gaps. If neccesary, use the Supplemental Employment History form to provide all information.
 
 
 
 
 
 
 
 
 
 
 
 

Professional Certifications

Criminal History

Have you ever been convicted of (or pleased guilty or no contest to or paid a fine for) ANY criminal offense of ANY type whatsoever(this includes but is not limited to felonies, misdemeanors, DWI, hunting offenses, domesticviolence, city or country ordinances)?
 Yes  No