Licensed Operator Application Form

Personal Information

If Less Than Three (3) Years, List Prior Address

Employment History (Most Recent First)

Personal References (Not Relatives)

Credit References

Do you have a major Credit Card? YesNo ( Please make a selection ).

Professional Information

Have you ever been involved in the service industry? YesNo ( Please make a selection ).

If Yes, Please Explain:

Have you ever dealt with people consuming alcohol? YesNo ( Please make a selection ).

If Yes, Please Explain:

Are you willing to provide a driver abstract and criminal record check? YesNo ( Please make a selection ).

Do you have a criminal record? YesNo ( Please make a selection ).

If Yes, Please Explain:

Driving Information

Do you feel comfortable driving in inclement weather? YesNo ( Please make a selection ).

How many years have you lived in the City?

Do you have good knowledge of the City? YesNo ( Please make a selection ).

Do you know how to read a map? YesNo ( Please make a selection ).

Do you have a GPS? YesNo ( Please make a selection ).

Do you have any demerits? YesNo (Please make a selection ).

If Yes, Please Explain:

Have you had any accidents? YesNo ( Please make a selection ).

If Yes, Please Explain:

Do you own or lease your vehicle? OwnLease ( Please make a selection ).

Enter the Make, Model and Year:

Can you drive a Standard Transmission? YesNo ( Please make a selection ).

If Yes, please provide a brief paragraph stating your experience driving standard transmission.

Medical Information

Do you have any medical conditions? YesNo ( Please make a selection ).

If yes, please explain:

Do you take any medication? YesNo ( Please make a selection ).

If yes, please explain:

Availability

Are you looking for:
Full TimePart Time - Please provide the days and hours you are available in the comment box below.

Partner's Name:

Has he/she completed an Application? YesNo (Please make a selection ).

How did you hear about us?
NewspaperAd ReferralWeb SearchExisting Keys Please LocationOther

How did you hear about the driving opportunity with Keys Please ®?
Explain:

It is expressly understood that the submission of this information does not constitute a contract and does not obligate either the company or the applicant in any manner. The applicant confirms that the information disclosed herein is accurate and true and that the company is entitled to use the appropriate means in determining that the information disclosed in this document is indeed a true reflection of the applicant's personal and financial qualifications.

All sources herein mentioned are authorized to provide you with any relevant information in confirming my personal and financial qualifications.

A signature will be required upon interview.

I have read the above and agree.

Verification:

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