Position applying for:
Social Security Number:
Full Legal Name:
Last
First
Middle Initial
Physical Address:
Street
Apt#
City
State
Zip
Mailing Address (if different):
Street
Apt#
City
State
Zip
Home Phone:
Cell Phone:
Other Phone:
E-Mail address:
Education:  Select the highest grade completed:
If you did not complete high school, do you have a high school equivalency diploma?
Select the number of year of post high school education:
Name/Location of Institution
Hours
Degree Received
Major or Specialty
Minor
Dates Attended
If you expect to complete an educational program in the near future, please indicate what type of degree or program and expected completion date:
License (to include driver's), certificate or other authorization to practice a trade or profession:
Type
License Number
Granted by (licensing board)
List names, addresses, and relationships of three persons not related to you who know your qualifications:
Name
Address
Phone
Relationship
Experience:  Beginning with the most recent, please describe all paid, military, and applicable voluntary experiences.  Highlight your knowledge, skills, and abilities which best demonstrate your qualifications for this position.  You may list significatly different jobs within the same organization as seperate items.
May we contact your supervisors?
Job #1:  Job Title:
Employer:
Address:
Street
Suite#
City
State
Zip
Type of business:
Phone:
Immediate Supervisor:
Title:
Salary (start):
Finish:
Dates (mo/yr):
to (mo/yr):
Full-Time        Part-Time
Hours per week:
Equipment used:
Reason for leaving:
Duties:
Job #2:  Job Title:
Employer:
Address:
Street
Suite#
City
State
Zip
Type of business:
Phone:
Immediate Supervisor:
Title:
Salary (start):
Finish:
Dates (mo/yr):
to (mo/yr):
Full-Time        Part-Time
Hours per week:
Equipment used:
Reason for leaving:
Duties:
Job #3:  Job Title:
Employer:
Address:
Street
Suite#
City
State
Zip
Type of business:
Phone:
Immediate Supervisor:
Title:
Salary (start):
Finish:
Dates (mo/yr):
to (mo/yr):
Full-Time        Part-Time
Hours per week:
Equipment used:
Reason for leaving:
Duties:
Please fill in the range of hours you are available to work using 24-hour clock.  If not available, write "N/A".
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Select the employment status you are applying for:
Are you willing to accept employment which requires you to travel overnight?
Are you willing to work on holidays?
Are you willing to work extended hours beyond your schedule run per your client's request?
Are you willing to take a pre-employment drug test as required by the company?
When will you be able to work?
Prior to your interview, you must provide an original DMV printout of your current driving record (H-6).
For purposes of compliance with the Immigration Reform and Contron Act, are you legally eligible for employment in the United States?
(Under the Immigration Reform and Control Act of 1986, you will be required to fill out a certification verifying that you are eligible to be employed and verifying your identity.  Further, you will be required to provide documentation to that effect should you be employed.)
Have you ever been convicted for any violation(s) of law, including moving traffic violations?
If yes, please provide the following:
Description of the offense and date of conviction:
In case of emergency, who should we contact?  Name:
Phone Number:
Relationship:
I hereby certify that all information in connection with this application is true and complete.  I agree and understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture on my part to any employement with Mystique Limousine Services, Inc.  I understand that all information on this application is subject to verification and I consent to criminal history background checks.  I also consent to references and former employers and educational institutions listed being contacted regarding this application.  I further authorize Mystique Limousine Services, Inc. to rely upon and use, as it sees fit, any information received from such contracts.  Information contained on this application may be disseminated to other agencies, nongovernmental organiations or systems on a need-to-know basis for good cause shown as determined by the agency head.
Do you accept the terms?
You may download our Employment Form by clicking on the line below labeled Employment Form and
Fax it to us at 626-815-1407.
Employment Form
 
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