Employment Application

                                     CHAINWHEEL  DRIVE, INC.

                           EMPLOYMENT  APPLICATION

 Personal Information:

Name ____________________________________________________ Date ______________

Present address _______________________________ City_____________State____Zip_____

Previous address ______________________________ City _____________State____Zip_____

How long at current address? ______________How long at previous address? ______________

Home phone number ___________________ Cell phone number ___________________

Email address _______________________________SS#_______________________________

Marital status: Single____ Married ____ Are you 18 years of age or older? Yes ____ No ______

Are you legally eligible for employment in the United States? Yes ____ No ____

Have you ever been charged with or convicted of a crime in any state (including felonies, misdemeanors, guilty pleas, or pleas of nolo contendre) other than minor traffic offenses?______ 

If
yes, please explain______________________________________________________________

 Note:  Applicants may be subject to a background check.  A prior charge or conviction
           will not 
necessarily bar you from employment; however, the type of conviction 
           and when it occurred will be considered. 

If hired, would you be able to perform all functions and all necessary job assignments of the particular job for which you are applying?  Yes ____ No ____ If no, please explain

____________________________________________________________________________

 Have you ever received workmen's compensation or disability income payments? Yes___No___

If yes, please describe___________________________________________________________

 

How did you learn of our organization? ______________________________________________

What interest or background in cycling do you have (activities, competition, home repair, etc.)?

_____________________________________________________________________________
 

 

Employment Interest:

 

Sales/merchandising ____ Technician ____ Assembler ____ Inventory control/purchasing ____

Bookkeeping ____ Office Assistant ____

Date available to start ____________  Pay/wages desired ____________________

Are you employed now? ______ If yes, may we contact your present employer? _______

If no, please explain ____________________________________________________________

Have you ever applied to Chainwheel Drive before?  Yes ____ No ____

Which location? ______________  When? _______________

Please indicate hours you can work.  If no limitations, list all.

Mon ______ Tues ______ Wed ______ Thur ______ Fri ______ Sat _______ Sun _______

Number of hours you wish to work per week: _________________

 

Education:
  Name and Location of School Subjects Studied/ Degree Did you graduate? # Years Attended
Elementary           School        
 
High          School        
 
College        
 
Trade or       Business        
 
Military Service:  Complete this section if you served in the U.S. Armed Forces.
Describe your duties and any special training______________________________________________
___________________________________________________________________________________
Branch of service________________________  Rank at discharge_____________________________
Period of active duty (Month & Year): From ____________  To _______________
Date of discharge _____________________________
Present membership in National Guard or Reserves ________________________________________
Employment History:
Please list your full-time and part-time employment record for your past four positions, starting with
your present or most recent employer and account for any periods of unemployment. Use a
separate sheet, if necessary.
Company Name  Telephone                                                
Address                                                               Dates Employed:From _______ To _______
Name of Supervisor Weekly Pay: Start ________ Last _________
State Job Title and Describe Your Work Reason for leaving                                          
         
Company Name  Telephone                                                
Address                                                               Dates Employed:From _______ To ________
Name of Supervisor Weekly Pay: Start ________ Last _________
State Job Title and Describe Your Work Reason for leaving                                          
         
Company Name  Telephone                                                
Address                                                               Dates Employed:From _______ To _______
Name of Supervisor Weekly Pay: Start ________ Last ________
State Job Title and Describe Your Work Reason for leaving                                          
         
Company Name  Telephone                                                
Address                                                               Dates Employed:From _______ To _______
Name of Supervisor Weekly Pay: Start ________ Last ________
State Job Title and Describe Your Work Reason for leaving                                          
         

Except for vacations and holidays, how many work days were you absent during the past calendar 
year?  0-5 days____ 6-10 days ____ 11-15 days ____ 16-20 days ____ 21+ days ____
References:  Give the names of three persons not related to you, whom you have known at least 
one year.
Name                        Address                                    Relationship to you      Phone   Years
Acqainted
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Service Department Supplement: (Service applicants only)
Please indicate your ability to perform the following tasks, WITHOUT SUPERVISION OR ASSISTANCE.
Answer the questions with a yes or no answer.  
Can you adjust:  Headsets? ______  Hubs? ______ Bottom brackets? ______                       
Can you overhaul:  Headsets? ______ Hubs? ______ Bottom brackets? ______
Can you install tires and tubes? ______ Can you install tubular tires? ______                 
Can you size and install A chain? ______  Do you know how to check A chain for wear? ______
Do you know how to adjust the limit screws on derailleurs? ______                                  
Can you install road bike brake lever/shifters (STI,Ergo) ? ______
Can you true wheels? ______   Can you build wheels? _______                                                                 
Can you replace spokes and find the proper length? ______
Can you overhaul spring/elastomer suspension forks? ______
Can you overhaul air/oil suspension forks? ______
CERTIFICATION:  (All applicants)
I hereby authorize the release of any employment data relevant to my employment with Chainwheel Drive, Inc. for the 
purpose of a bonafide credit and employment investigation.  I authorize a  thorough investigation of my past employment
activities, and background and agree to cooperate in such investigation, and release from all liability or responsibility all
persons and corporations requesting or supplying such information.  This investigation shall also include a determination
regarding whether I have a criminal record.
I fully understand that if employed, any misrepresentation or omission on this application will result in dismissal, 
regardless of the date of discovery.  Employment may also be subject to my passing a medical examination as required
by the Personnel policies of Chainwheel Drive, Inc. and to a satisfactory review of my references.
I understand that neither the Application nor any statement made to me during the hiring process or thereafter shall be
considered a contract of employment of any kind. Where such a contract is intended, I understand that it will be
separately entered into and signed by the President of the Company.
Signature: _______________________________________   Date: ____________________