Application for employment

Applicant Information

Tell us about yourself and how we can reach you.

First Name

Last Name

Middle Initial

Street Address

City

State / Zip

Phone Number

Alternate Phone

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Position Information

Tell us about yourself the position and your availability.

Position you’re applying for

Available to start

Employment type

Full-time

Part-time

Temporary

Seasonal

Can you work the required schedule, including overtime if authorized?

Yes

Where you referred by someone

Do you have any relatives currently employed by carcapitol.ai?

Yes

Relative Name

Relationship

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Driving Positions Only

Complete this step only if driving is an essential function of the position.Do not provide your date of birth or age.

Do you currently possess a valid driver's license required to perform the driving duties of the position?

Yes

Not applicable

Can you provide proof of required license, DMV record, and insurability if requested after a conditional offer or as otherwise permitted by law?

Yes

Not applicable

License class, endorsement, or restriction information relevant to the position, if any

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Reasonable Accommodation / Essential Functions

carcompany.ai provides reasonable accommodations to qualified applicants and employees with disabilities, consistent with applicable law. You do not need to disclose a diagnosis or medical condition on this form

Can you perform the essential functions of the position, with or without reasonable accommodation?

Yes

If you need an accommodation for the application or interview process, describe the accommodation requested or contact the company representative handling the application process.

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Education and Training

Tell us about your education and any job-related training or skills.

High School or Equivalent

Name and Location

Degree, Diploma, Certificate, or Coursework Completed

Job-Related Training / Skills

College / University / Technical School

Name and Location

Degree, Diploma, Certificate, or Coursework Completed

Job-Related Training / Skills

Trade / Business / Military Training

Name and Location

Degree, Diploma, Certificate, or Coursework Completed

Job-Related Training / Skills

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Employment Experience

List your present and past employment, starting with the most recent. The last five years or last three jobs is sufficient. Do not include prior salary, wage, or compensation history

Employer 1

Company Name

Employment Dates: From / To

–

Type of Business

Phone Number

Street Address

City / State / Zip

Supervisor Name / Title

May we contact this employer for a reference?

Yes

Position Held

Reason for Leaving

Description of Duties

If attaching a resume, note the relevant section/page here.

Employer 2

Company Name

Employment Dates: From / To

–

Type of Business

Phone Number

Street Address

City / State / Zip

Supervisor Name / Title

May we contact this employer for a reference?

Yes

Position Held

Reason for Leaving

Description of Duties

If attaching a resume, note the relevant section/page here.

Employer 3

Company Name

Employment Dates: From / To

–

Type of Business

Phone Number

Street Address

City / State / Zip

Supervisor Name / Title

May we contact this employer for a reference?

Yes

Position Held

Reason for Leaving

Description of Duties

If attaching a resume, note the relevant section/page here.

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Professional References

List three people who can comment on your job-related experience, education, or qualifications. Do not list relatives unless specifically requested.

Reference 1

Full Name

Title / Company

Phone Number

Email Address

Employer 2

Full Name

Title / Company

Phone Number

Email Address

Employer 3

Full Name

Title / Company

Phone Number

Email Address

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Applicant Certification and Acknowledgment

Review and acknowledge the statements below before submitting your application.

Initial: I certify that the information I provide in this application and in any attachments is true, complete, and correct to the best of my knowledge. I understand that any material misstatement or omission may result in rejection of my application or, if I am employed, separation from employment, subject to applicable law.

Initial: I authorize carcompany.ai to verify information related to my employment history, education, qualifications, and references to the extent permitted by law. This application does not authorize Carcompany.ai to obtain a consumer report or investigative consumer report. If such a report is sought, I understand I will receive any legally required disclosure and authorization forms separately.

Initial: I understand that, if hired, I will be required to provide proof of identity and authorization to work in the United States and complete the required employment eligibility verification process.

Initial: I understand that employment with carcompany.ai is at will unless a written agreement signed by an authorized officer of the company states otherwise. This means either I or Carcompany.ai may end the employment relationship at any time, with or without cause or notice, subject to applicable law.

Printed Name

Date

Applicant Signature

Draw signature

Clear

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California Applicant Privacy Notice at Collection

This notice is a summary for California applicants. It should be tailored to the company's actual data practices, retention schedule, vendors, and privacy request procedures before use.

Categories of Personal Information Collected: Identifiers and contact information; professional or employment-related information; education information; references; application materials; interview notes and assessments; job-related licensing, certification, and driving qualification information where applicable; and other information you voluntarily provide. Do not provide sensitive personal information unless specifically requested for a lawful, job-related purpose.

Purposes for Collection and Use: Recruiting, evaluating qualifications, scheduling interviews, communicating with applicants, verifying references and qualifications, complying with legal obligations, protecting company rights and safety, and administering the hiring process.

Disclosures: Information may be disclosed to service providers, professional advisors, government authorities when required by law, and other parties as needed for recruiting, verification, compliance, security, or business operations. Background checks, if any, will be handled through separate legally required notices and authorizations.

Retention: Application information will be retained only as long as reasonably necessary for the hiring process, legal compliance, recordkeeping, dispute resolution, and legitimate business purposes, according to the company's retention schedule.

Applicant Rights and Contact: California applicants may have rights under California privacy law, depending on whether the company is covered by those laws. To submit a privacy request or ask questions, contact:
careers@carcompany.ai

Prepared as a California-oriented application template. This document should be reviewed by employment counsel before implementation, especially if used with automated screening, third-party background checks, unionized positions, government contracts, commercial driver roles, or regulated transportation roles.

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