Application

Mobile Lube Equipment

Application for Employment

PLEASE READ BEFORE FILLING OUT THIS APPLICATION
No question on this application is intended to secure information to be used for a discriminatory purpose, as this company is an equal employment opportunity employer and does not discriminate on the basis of race, color, religion, sex, citizenship, national origin, age, veteran or marital status, disability, or any other legally protected status.

APPLICANT'S STATEMENT OF UNDERSTANDING AND AUTHORIZATION:
I understand and authorize the company to obtain a consumer report on my financial and credit record as well as an investigative consumer report whereby information is obtained through personal interviews with neighbors, friends and others with whom I am acquainted. This investigation includes information as to my character, general reputation, personal characteristics and mode of living. I understand that I have the right to make a written request within a reasonable period of time to receive additional, detailed information about the nature and scope of this investigative consumer report. I give my permission to the company to contact any of the former employers or references shown below to verify the information I have given and I authorize previous employers to release all records of my employment, including assessments of my job performance, ability and fitness.

I understand that the company may require a Motor Vehicle Record (MVR) report.

I understand that the company reserves the right to require a conditional offer of employment medical examination as well as periodic physical or medical examinations, a pre-employment as well as post-employment drug/alcohol test, to the extent permitted by law. I understand that a polygraph (lie detector) examination, to the extent permitted by law, may be given by the company during employment.

I hereby state that the information given by me in this application is true in all respects, and I agree that if I am employed and the information is found to be false in any respect that I may be dismissed.

Should I be employed I understand that such employment will not result in an employment contract for any specific
term.

I. PERSONAL DATA

Name *		Last Name *
Middle Name
Present Address		City *
State *		Zipcode *
Previous Address		City
State		Zipcode
Emergency Phone No. *		Home or Nearest Telephone No.
Are you over the age of 18?	Yes No	Mobile Phone
	If no, employment is subject to verification that applicant is of minimum legal age.
Are you legally authorized to work in the United States?	Yes No
Do you have a valid operator's permit (driver's license)?	Yes No	State : License Number :	Expiration Date :
Any restrictions on license	Yes No	If yes, explain
Do you hold any other operator's permits? If yes, explain		Do you hold a commercial driver's license?	Yes No

During the last seven (7) years, have you ever been convicted of, or have you pleaded guilty or no contest (nolo contendere) to a felony offense?			Yes No
If yes, please explain. (Answering "yes" will not automatically bar you from employment. However, we would appreciate an explanation.
Have you ever been convicted of a DWI (Driving While Intoxicated or Driving under the Influence)	Yes No	If yes, give date and details of each conviction:

II. EDUCATION (List all education and training)

CLASSIFICATION	NAME AND LOCATION	MAJOR SUBJECT	DIPLOMA/DEGREE
COLLEGE
BUSINESS SCHOOL
VOCATIONAL
HIGH SCHOOL
OTHER
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:

III. CHARACTER REFERENCES

NAME	OCCUPATION	ADDRESS (STREET, CITY AND STATE)	TELEPHONE NUMBER	NO. OF YEARS KNOWN

List names of employers in consecutive order with present or last employer listed first. Account for any gaps and any period of unemployment. If self-employed, give firm name and supply business referenced. PLEASE GIVE MONTH AND YEAR.

Name of Present or Last Employer		Address
City		State
Zip Code		Employee's Title
Employed From		Employed To
Pay Start		Pay Final
Name of Last Supervisor		Telephone
Reason for Leaving

Name of Present or Last Employer		Address
City		State
Zip Code		Employee's Title
Employed From		Employed To
Pay Start		Pay Final
Name of Last Supervisor		Telephone
Reason for Leaving

Name of Present or Last Employer		Address
City		State
Zip Code		Employee's Title
Employed From		Employed To
Pay Start		Pay Final
Name of Last Supervisor		Telephone
Reason for Leaving

Explain any gaps in your employment history set forth above
Position(s) applied for
How soon could you report to work?	0
Type of employment	Full-Time	Part-Time	Temporary
What days and hours if part-time? Day		Hour
Rate of pay expected?	1	Are you presently employed?	2
If yes, why do you desire to make a change?	3
What makes of equipment do you know best?	4
Have you ever worked for this company before?	Yes No	If yes, give dates and position held	5

IV. GENERAL INFORMATION
Please check actual experience in any of the following:

PRODUCTION & ASSEMBLY

Service Manager	Body Person	Car Washer	Welder / Fabricator
Shop Foreman	Paint Person	Lubrication Person	Welder’s Helper
Machinist	Helper	Janitor	Assembly Helper
Mechanic	Trimmer (Upholsterer)	Parts Clerk	Assembly
Mechanic Helper	Polisher	Parts Delivery
Electrician	Porter	Parts Manager

SALES, MARKETING, ADMINISTRATION

Sales Manager	Salesperson	Office Manager	Secretary
Human Resources	Marketing Coordinator	Bookkeeper	Clerk
Warranty Manager	Marketing Manager	Cashier

APPLICANT DATA RECORD

Applicants are considered for all positions and during employment all employees are treated without regard to race, color, religion, sex, national origin, ancestry, age, veteran status, disability, and any other legally protected status. As an employer we comply with government regulations, including affirmative action responsibilities where they apply. For the sole purpose of helping us comply with government record keeping, reporting, and other legal requirements, we request that you complete this data record. Thank you for your cooperation.
This data is for periodic government reporting and will be kept in a Confidential File separate from the Application for Employment.
YOUR COOPERATION IS VOLUNTARY.

Name *		Phone *
Address		Position(s) Applied For *
Email-ID *		Referral Source

VOLUNTARY SURVEY

Check One:

Female Male

Check one of the following:

	American Indian/Alaskan Native		Native Hawaiian/Pacific Islander
	Black (African American)		Hispanic
	White		Asian
	Two or More Races

Check if any of the following are applicable:

	Vietnam Veteran		Disabled Vet
	Disabled Individual

Enter the code

APPLICANT'S CERTIFICATION

I certify that the information contained in this application is correct to the best of my knowledge and understand that Falsification of this information is a ground for dismissal. I authorize the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I agree to conform to the rules and regulations of the Company. I understand that if an offer of employment is extended that it is conditioned upon completing the Federal I-9 form and providing documents establishing identity and work authorization. I understand that this employment application and any other Company document are not promises of employment. I understand that my employment can be terminated with or without cause and with or without notice, at any time, at the option of either the Company or myself. I understand that no manager or representative of the Company, other than the President, has the authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.