onboarding

Section 1 - Personal Information

This application form helps the company evaluate your suitability for employment. Please answer completely and accurately.

Name *

First

Middle

Last

Present address *

Address Line 1

Address Line 2

City

State

Zip Code

No. years at present address *

Previous address

Address Line 1

Address Line 2

City

State

Zip Code

No. years at previous address

Social Security Number *

Home telephone *

Work telephone

OK to call at work? *

Yes
No

Cell telephone *

Please provide any special information about your name for verification purposes

Are you employed? *

Yes
No

On what date would you be available for work? *

Goals (What would you like to be doing in 2 years?) *

Emergency Contact Name *

Emergency Contact Phone *

Section 2 - Employment Interest

Position desired *

If hired, can you provide documents proving you are legally able to work in the U.S.? *

Yes
No

Can you perform the essential job functions for this position? *

Yes
No

Can you work 8 am – 6 pm, Monday through Friday? *

Yes
No

Can you work 8 am to 1 pm, Saturday? *

Yes
No

Do you have any schedule restrictions? *

Yes
No

Are you willing to be "On-Call" for emergencies? *

Yes
No

If yes to any restrictions, please explain

Are you willing to travel if the job requires it? *

Yes
No

Have you worked for this company before? *

Yes
No

If yes, when and in what position?

Have you ever been convicted of a crime? *

Yes
No

If yes, please explain

Section 3 - Education and Skills

High School Name

High School City, State

High School - Did you graduate?

Yes
No

College/University Name

College/University City, State

Degree/Major

College - Did you graduate?

Yes
No

Other Education/Training Name

Other Education/Training City, State

Other Education - Degree/Certificate

Other Education - Did you graduate?

Yes
No

List any additional skills or training that may benefit this position

List professional licenses or certifications

Section 4 - References

Please provide 3 professional references (not relatives).

Reference 1

Reference 1 - Name *

Reference 1 - Relationship *

Reference 1 - Company *

Reference 1 - Phone Number *

Reference 1 - Email *

Reference 2

Reference 2 - Name *

Reference 2 - Relationship *

Reference 2 - Company *

Reference 2 - Phone Number *

Reference 2 - Email *

Section 5 - Employment History

Please list your work experience, starting with your most recent employer.

Current or Most Recent Employer

If this information is already included in your resume, you may skip this section. However, please complete your Reason for Leaving your last occupation regardless.

Company Name

Address

Supervisor Name

Supervisor Phone

Job Title

Start Date

End Date

Responsibilities

Reason for Leaving *

Starting Salary

Ending Salary

May we contact this employer?

Yes
No

Previous Employer #1

Company Name

Address

Supervisor Name

Supervisor Phone

Job Title

Start Date

End Date

Responsibilities

Reason for Leaving

Starting Salary

Ending Salary

May we contact this employer?

Yes
No

Previous Employer #2

Company Name

Address

Supervisor Name

Supervisor Phone

Job Title

Start Date

End Date

Responsibilities

Reason for Leaving

Starting Salary

Ending Salary

May we contact this employer?

Yes
No

Section 6 - Military Experience

Have you served in the U.S. Armed Forces? *

Yes
No

Branch of Service

Service Start Date

Service End Date

professional Reference Reference

Rank at Discharge

Type of Discharge

Military Skills/Training

Section 7 - Acknowledgement and Authorization

I certify that all information provided in this application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.

I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.

I understand that this company may require me to successfully pass a drug screening and/or physical examination. I hereby give my permission for this company to conduct such screening or examination.

Agreement *

I have read and understand the above statements and agree to these terms

Applicant Signature *

Clear Signature

Date Signed *

Benefits Information

Please complete the following sections regarding your benefits enrollment.

Health Insurance

Would you like to enroll in health insurance? *

Yes
No

Coverage Level

Employee Only
Employee + Spouse
Employee + Children
Family

Dental Insurance

Would you like to enroll in dental insurance? *

Yes
No

Coverage Level

Employee Only
Employee + Spouse
Employee + Children
Family

Vision Insurance

Would you like to enroll in vision insurance? *

Yes
No

Coverage Level

Employee Only
Employee + Spouse
Employee + Children
Family

401(k) Retirement Plan

Would you like to enroll in the 401(k) plan? *

Yes
No

Contribution Percentage (0-50%)

Primary Beneficiary Name

Primary Beneficiary Relationship

Primary Beneficiary Percentage

Contingent Beneficiary Name

Contingent Beneficiary Relationship

Contingent Beneficiary Percentage

Direct Deposit Authorization

Fleet Appliance Corp requires all employees to enroll in direct deposit. Please provide your banking information below.

Bank Name *

Bank Address

Bank City

Bank State

Bank ZIP Code

Routing Number *

Account Number *

Account Type *

Checking
Savings

Authorized Signature (Primary) *

Clear Signature

Authorized Signature (Joint)

Clear Signature

Please attach a voided check or deposit slip.

Void Check Upload

Drag & Drop Files, Choose Files to Upload

Emergency Contact Form

Employee Name *

Address *

Phone Number *

Special Instructions

Medical emergency procedures or medication restrictions

Primary Emergency Contact

Primary - Name *

Primary - Relationship *

Primary - Address *

Primary - Phone Number *

Primary - Alternate Phone Number

Secondary Emergency Contact

Secondary - Name *

Secondary - Relationship *

Secondary - Address *

Secondary - Phone Number *

Secondary - Alternate Phone Number

Employee Authorization

I authorize Fleet Appliance Corp to contact the above individuals in an emergency.

Employee signature *

Clear Signature

Form W-4: Employee's Withholding Certificate

Complete the official IRS Form W-4 electronically, then upload it here.

Instructions:

Visit the IRS website: https://www.irs.gov/pub/irs-pdf/fw4.pdf
Download and complete the form
Save as PDF
Upload below

This is a required federal tax form.

Upload completed Form W-4 (PDF) *

Drag & Drop Files, Choose Files to Upload

Form IT-2104: Employee's Withholding Allowance Certificate

New York State • New York City • Yonkers

Complete the official NYS Form IT-2104 electronically, then upload it here.

Instructions:

Visit: https://www.tax.ny.gov/pdf/current_forms/it/it2104.pdf
Download and complete the form
Save as PDF
Upload below

This is a required New York State tax form.

Upload completed Form IT-2104 (PDF) *

Drag & Drop Files, Choose Files to Upload

Form I-9: Employment Eligibility Verification

U.S. Citizenship and Immigration Services

Instructions:

Visit USCIS: https://www.uscis.gov/i-9
Complete Section 1
Prepare copies of acceptable documents (List A, or List B + List C)
Save as PDF
Upload form and supporting documents below

Required Documents:

List A: Docs proving identity AND work authorization (e.g., U.S. Passport, Permanent Resident Card)
OR List B + C: Identity doc (e.g., Driver's License) + Work authorization doc (e.g., Social Security Card)

This is a required federal form.

Upload completed Form I-9 (PDF) *

Drag & Drop Files, Choose Files to Upload

Upload I-9 supporting documents *

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

Section 1 - Personal Information

Section 2 - Employment Interest

Section 3 - Education and Skills

Section 4 - References

Reference 1

Reference 2

Section 5 - Employment History

Current or Most Recent Employer

Previous Employer #1

Previous Employer #2

Section 6 - Military Experience

Section 7 - Acknowledgement and Authorization

Benefits Information

Health Insurance

Dental Insurance

Vision Insurance

401(k) Retirement Plan

Direct Deposit Authorization

Emergency Contact Form

Primary Emergency Contact

Secondary Emergency Contact

Employee Authorization

Form W-4: Employee's Withholding Certificate

Form IT-2104: Employee's Withholding Allowance Certificate

Form I-9: Employment Eligibility Verification

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