Application for Employment
Avis is an equal opportunity employer		 ( ) denotes a required field
PERSONAL INFORMATION
NAME
Last:   First:   MI:
APPLICATION DATE:
09/05/2010
CURRENT ADDRESS
Street:
City:   State:   Zip:
PHONE NUMBERS   (at least one)
Home:
Cell:
Business:
PREVIOUS ADDRESS
Street:
City:   State:   Zip:
How long at current address?
Years:
Months:
E-MAIL ADDRESS
 REFERRED BY

Person's Name, Name of Newspaper, Other
Have you ever applied to, or been employed by Avis before?
Yes, I have. No, I have not.
If so, when and where?
Are you legally eligible for employment in the United States?
Yes, I am. No, I am not.
Before you are hired, you will be asked to produce evidence that you are legally eligible for employment.
Have you been convicted of a crime within the last five years?
Yes, I have. No, I have not.
If yes, what was the crime and date of conviction?
Is any criminal charge pending against you at this time?
Yes, there is. No, there is not.
If yes, what is the charge pending?
CRIMINAL RECORDS OR PENDING CHARGES DO NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT AND WILL BE CONSIDERED ONLY AS THEY RELATE TO THE JOB BEING APPLIED FOR.
AVAILABILITY
LOCATION APPLYING FOR
 AVAILABLE FOR
TOTAL HOURS AVAILABLE PER WEEK
 DATE YOU CAN START
POSITION DESIRED
  Full Time   Part Time  
SALARY DESIRED
HOURS AVAILABLE Sunday Monday Tuesday Wednesday Thursday Friday Saturday
FROM
TO
EDUCATION
NAME OF SCHOOL / LOCATION / CITY & STATE
HIGH SCHOOL
Name:
City:   State:
NO. OF YRS
ATTENDED
TYPE OF DEGREE
EMPHASIS ON
COLLEGE
Name:
City:   State:
NO. OF YRS
ATTENDED
TYPE OF DEGREE
MAJOR/MINOR
GRADUATE SCHOOL
Name:
City:   State:
NO. OF YRS
ATTENDED
TYPE OF DEGREE
MAJOR/MINOR
BUSINESS / TECHNICAL SCHOOL
Name:
City:   State:
NO. OF YRS
ATTENDED
TYPE OF DEGREE
MAJOR/MINOR

List below any special skills/professional licenses you may have to offer
(Example: typing, steno, personal computer, languages)

EMPLOYMENT HISTORY - LIST FORMER EMPLOYERS STARTING WITH MOST CURRENT
If you are currently employed, may we contact your current employer? Yes   No
EMPLOYER NAME
ADDRESS
PHONE NUMBER
SUPERVISOR NAME AND TITLE
REASON FOR LEAVING
FROM (mm/yy)
TO (mm/yy)
Start Position: Start Salary:
Final Position: Final Salary:
EMPLOYER NAME
ADDRESS
PHONE NUMBER
SUPERVISOR NAME AND TITLE
REASON FOR LEAVING
FROM (mm/yy)
TO (mm/yy)
Start Position: Start Salary:
Final Position: Final Salary:
EMPLOYER NAME
ADDRESS
PHONE NUMBER
SUPERVISOR NAME AND TITLE
REASON FOR LEAVING
FROM (mm/yy)
TO (mm/yy)
Start Position: Start Salary:
Final Position: Final Salary:
EMPLOYER NAME
ADDRESS
PHONE NUMBER
SUPERVISOR NAME AND TITLE
REASON FOR LEAVING
FROM (mm/yy)
TO (mm/yy)
Start Position: Start Salary:
Final Position: Final Salary:
EMPLOYER NAME
ADDRESS
PHONE NUMBER
SUPERVISOR NAME AND TITLE
REASON FOR LEAVING
FROM (mm/yy)
TO (mm/yy)
Start Position: Start Salary:
Final Position: Final Salary:
US MILITARY SERVICE
US MILITARY SERVICE DATES
From: To:
BRANCH OF SERVICE
 RANK AT DISCHARGE
SPECIAL TRAINING
REFERENCES - NO FORMER EMPLOYERS OR RELATIVES
NAME AND ADDRESS POSITION TELEPHONE YEARS KNOWN
PLEASE ANSWER THE FOLLOWING QUESTIONS
1. During the last 12 months, have you used any of the following controlled substances or prescription medications without an authorized prescription?
Marijuana
Cocaine/Cocaine Base (Crack)
Speed/Amphetamines/Methamphetamines
Heroin
LSD/Hallucinogens
PCP
Ecstasy
Other
2. If you have used any of these substances within the last 12 months, when was the last time?
3. Have you since quit using controlled substances?
4. Within the last 12 months have you been disciplined or terminated from employment for the use of controlled substances or alcohol?
5. Have you ever been disciplined or terminated by a former employer for:
Absenteeism or tardiness
Theft, unauthorized removal of company property or related offenses
Fighting, assault or related offenses
Insubordination
Violating a safety rule
DRIVERS LICENSE HISTORY RECORD
DRIVERS LICENSE
Number:
Exp. Date:   State:
Are you atleast 18 years of age?
Yes, I am. No, I am not.
How long have you been licensed?  
Do you have a probationary drivers license?
Yes, I do. No, I do not.
Within the last five years have you had your license suspended or revoked?
Yes, I have. No, I have not.
If yes, when was it reinstated?
Within the last five years have you been convicted of driving while impaired or intoxicated?
Yes, I have. No, I have not.
If yes, please explain in detail.
Are you taking any prescription or non-prescription drugs which could interfere with your driving skills?
Yes, I am. No, I am not.
If yes, please explain in detail.
LIST ALL MOVING VIOLATIONS IN THE PAST 5 YEARS
DATE VIOLATION
DATE VIOLATION
DATE VIOLATION
DATE VIOLATION
Please list any additional moving violations
LIST ALL ACCIDENTS IN THE PAST 5 YEARS REGARDLESS OF WHO WAS RESPONSIBLE
DATE LOCATION NO. PERSONS
INJURED /
KILLED		 AMOUNT OF DAMAGE IN $ TO CAR YOU WERE DRIVING AMOUNT OF DAMAGE IN $ TO OTHER DRIVERS CAR OR OTHER PROPERTY
RESUME


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AGREEMENT
PLEASE READ CAREFULLY BEFORE SUBMITTING ELECTRONICALLY

I understand that this application will be processed as if I have signed it. By submitting this application I acknowledge that I have read and agree to the following:

I certify that the information given by me is true and correct and without any omission.

I understand that any false statement on this application may disqualify me for employment or may lead to my discharge at any time during employment.

I acknowledge that consideration for employment is contingent on the results of a reference and background check. Therefore, I hereby authorize Avis to (1) investigate the truthfulness of all statements made on this application; (2) contact my former employers and other listed references and any other persons who can verify information; and (3) discuss the results of any investigation with other employees of the company involved in the hiring process. In addition, I give my consent for all contacted persons including former employers to provide information concerning this application, and I release each such person from liability for providing information to Avis. I also authorize Avis to obtain and review my driving record.

I understand that if I make a written request within a reasonable time of this application, Avis will inform me of the nature and scope of any investigation conducted.

I understand that all information obtained during pre-employment screening is held by Avis in the strictest confidence and will not be released to anyone unless Avis is specifically authorized to do so by me or as required by law.

I further understand that if I am hired, I will not have an employment contract and that my employment and compensation can be terminated with or without notice or cause at any time by me or by Avis.

Avis is not responsible for unauthorized interception of materials submitted electronically.
Yes, I agree with the above statements.
Avis Rent a Car . PO Box 1935 . Appleton, WI 54912
Customer Service: 920-730-7570 . Car Sales: 920-730-7560
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