Smart Park, Inc. 900 E. 2nd St. Essington, PA 19029
Fax: 610-521-3500
Email: positions@smartpark.com
Expresspark South, Inc.
55 Industrial Highway Essington, PA 19029
Fax: 610-521-0300
Email: positions@expresspark.net
(Pre-employment Questionnaire)
(An Equal Opportunity Employer)
Personal Information
Date
First
Middle
Last
Address
Address Line 2
City
State
AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyomingDistrict of Columbia
Zip Code
Phone Number
Are you at least 18 years old?
YesNo
Are you either a U.S. citizen or an alien authorized to work in the United States?
Position
—Please choose an option—DriverCashierSupervisor
Desired Start Date
Desired Salary
Are you employed now?
Can we make contact your present employer?
Ever applied to this company before?
Where
When
Referred By
U.S. Military or Naval Service?
Rank
Present Membership in National Guard or Reserves
*The Age Discrimination in Employment Act of 1987 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age
(List below last three employers, starting with last one first)
From
To
Employer Name
Employer Address
Salary
Reason for Leaving
Driver's License #
Classes
Expiration Date
Issue Date
Birthdate
Endorsements
Medical Restrictions
Previous Driving Experience
What shift would you prefer?
Part-timeFull-timeWeekdays1st Shift2nd Shift3rd Shift
Only Certain Days (choose all that apply)
SundayMondayTuesdayWednesdayThursdayFridaySaturday