Job Application Form

Note: You can also download this application and FAX it back to us at 309.799.5945.

All statements made by applicants for employment on this application will be checked for accuracy. Elliott Aviation offers equal employment opportunities to all persons without discrimination on the basis of race, color, religion, age, marital status, sex, national origin, citizenship status, physical or mental disability, or past present or future service in the Uniformed Services of the U.S., or any other legally protected status. The use of this form does not mean there are positions open and does not obligate us in any way.

Legal Name
* Prefix:
* First Name:
* Last Name:
Suffix:
* Social Security Number:
Address
* Street:
* City:
* State:
* Zip Code:

Home Phone:
Business Phone:
Email:

Position for which applying:
Location:
Work Hours:	F/T P/T Temp.
If part time, what days and hours?
What is your minimum salary requirement?
Date Available:
Have you ever worked for Elliott Aviation , Inc. before?	Yes No
Have you ever applied to Elliott Aviation, Inc. before?	Yes No
How were you referred to us?	Employee Referral Former Employee Walk-In School Recruitment Advertisement Other
Other
Why do you desire a change in employment?
Have you ever been discharged or requested to resign a position of employment?	Yes No
If yes, please explain
Are you legally eligible for work in the USA? (Note: Proof of citizenship or immigration)	Yes No
Are you 18 years of age or older	Yes No
Do you have a valid driver's license?	Yes No
Is there anything which would prevent you from performing the essential functions of the position for which you are applying?	Yes No
If yes, please explain:
Have you ever been convicted of a crime in the past 7 years (excluding sealed or expunged convictions)? (Note: a "yes" response will not necessarily disqualify you from consideration)	Yes No
If yes, please explain:

Education
High School:
Name/Location
Last Year Completed	9 10 11 12
Type of Course or Major
Did you graduate?	Yes No
Degree received

College:
Name/Location
Last Year Completed	1 2 3 4
Type of Course or Major
Did you graduate?	Yes No
Degree Received

Trade or Business:
Name/Location
Type of Course or Major
Did you graduate?	Yes No
Degree Received

SKILLS
Please provide any additional information such as special skills, training, management experience, equipment operation or qualifications you feel will be helpful to us in considering your application:


U.S. Military Service:
Have you ever served in the U.S. Armed Forces?	Yes No
If yes, in what branch?
Dates of Duty - From:
To:
Rank at time of Enlistment
Rank at time of Separation
Special Training:
Briefly describe your duties:

Certification Information:
Pilot Cert. #
Student, Priv., Comm., ATP, Flt Inst., Gr. Inst., Sim, Inst., Other	Student Private Commercial ATP Flight Instructor Graduate Instructor Simulation Instructor Other
Total Flight Experience:
PIC
SIC
S/E/L
R/G
MEL
S/E/S
M/E/S
TURBINE
PROP
Jet
ROTOCRAFT

INSTRUMENT:
Actual
Simulation

Current FAA Physical -
Class
Date Taken

Mechanic Cert #
Type	A&P A only P only AI
Other

EMPLOYMENT HISTORY
This section must be complete. A resume will not substitute for the completed application.
1. Last/Current Employer
Address:
City/State/Zip
Telephone
Dates of Employment (Mo./Yr.)
From:
To:
Supervisor's Name
Job Title:
Salary
Start:
End:
Duties:
Reason for Leaving:
May we contact this employer?	Yes No

2. Employer
Address:
City/State/Zip
Telephone
Dates of Employment (Mo./Yr.)
From:
To:
Supervisor's Name
Job Title:
Salary
Start:
End:
Duties:
Reason for Leaving:
May we contact this employer?	Yes No

3. Employer
Address:
City/State/Zip
Telephone
Dates of Employment (Mo./Yr.)
From:
To:
Supervisor's Name
Job Title:
Salary
Start:
End:
Duties:
Reason for Leaving:
May we contact this employer?	Yes No

4. Employer
Address:
City/State/Zip
Telephone
Dates of Employment (Mo./Yr.)
From:
To:
Supervisor's Name
Job Title:
Salary
Start:
End:
Duties:
Reason for Leaving:
May we contact this employer?	Yes No

REFERENCES
List names, addresses and telephone numbers of three references who are not related to you who have knowledge of your skills and abilities in the area for which you have applied.
Name
Address
Phone Number

Name
Address
Phone Number

Name
Address
Phone Number

Please include any other information you think would be helpful to us in considering you for employment, such as additional work experience activities, accomplishments, etc. (You may exclude all information which may disclose your age, sex, race, religion, color, national origin, disabilities or other legally protected status.)

APPLICANT ACKNOWLEDGEMENT	Yes No
I certify that the information provided on the application (and my accompanying resume, if any) is true and complete to the best of my knowledge and agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date.

In making this application, I also understand that all information I have furnished may be investigated for verification by contacting former employers (except where otherwise indicated herein), references and any parties or sources who may have information Elliott Aviation, Inc. deems relevant to my employment, including criminal, educational, and driving records. I authorize Elliott Aviation, Inc. and its representatives to conduct such an investigation and release from all liability or damage those individuals, firms or employers who may provide any such information and Elliott Aviation, Inc. in gathering such information.

Ours is an alcohol and drug free workplace. I understand that if I am offered employment with Elliott Aviation, Inc., a preemployment physical examination and drug test (with negative results) is required. The drug test is a condition of hiring and continued employment. This is mandatory for ALL safety sensitive employees covered under the FAA Regulations 14 CFR Parts 121, 135 and 49 CFR Part 40 (Flight Crew Member, Flight Attendant, Flight Instructor, Aircraft Dispatcher, Ground Security Coordinator, Aircraft Maintenance Technician, Aviation Screener, Air Traffic Controller). I understand that Elliott Aviation, Inc. may be required to notify the Federal Aviation Administration of an adulterated test result, as required by the Federal Aviation Regulations. Drugs tested for are marijuana, cocaine, opiates, PCP and amphetamines. I certify that I am not permanently disqualified from performing any safety-sensitive duties by the FAA due to a violation of a previous employer's Anti-Drug or Alcohol Misuse Program. I further agree that if I attain employment with Elliott Aviation, Inc. I may (as required by the Federal Aviation Administration) participate in the random Drug & Alcohol Testing programs.

I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between Elliott Aviation, Inc. and myself for either employment or for the providing of any benefit. No promises have been made to me, and I understand that if I obtain employment with Elliott Aviation, Inc., my employment will not be for a fixed period time and that it can be terminated by the company, or me, with or without notice for any reason or for no reason, and without liability for wages, salary or other compensation or benefits except what I have earned as of the date of termination, or specified by federal, state or local law.

APPLICANT DATA RECORD

Our organization is committed to the employment and advancement of minorities, individuals with disabilities and veterans. Prospective employees will receive consideration without regard to race, color, religion, sex, national origin, age veteran status, disability, or any other legally protected status.
As an employer with an Affirmative Action Program, we comply with government regulations, including Affirmative Action responsibilities where they apply.
The purpose for this Data Record is to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of this Data Record is optional. If you choose to volunteer the requested information, please note that once the date is recorded it is maintained in a separate file.
*Your Cooperation is Voluntary. Inclusion or Exclusion of any Data Will Not Affect any Employment decision.*

VOLUNTARY SURVEY
Government agencies at times require periodic reports on the sex, ethnicity, disability, veteran and other protected status of prospective employees. The data is for the statistical analysis with respect to the success of the Affirmative Action Program. *SUBMISSION OF THIS INFORMATION IS VOLUNTARY.*
Name:
Position(s) Applied For:
Referral Source:	College Placement Office Newspaper Walk-In Friend Elliot Aviation, Inc. employee Employment Agency State Job Service Other
Check One:	Male Female
Check One Of The Following:	American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Hispanic or Latino (All races)
Check If Any Of The Following Are Applicable:	Veteran of the Vietnam Era Other Protected Veteran Newly Separated Veteran (wthin the past on-year period) Disabled Veteran