Application For Employment

We consider applications for all positions without regard to race, color, religion, creed, sex, national origins, disability, sexual orientation, citizenship status or any other legally protected status.

Position(s) Applied For:


How did you learn about us?
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Relative
Inquiry
Employment Agency
Friend
Other
Other:


Last Name:


First Name:


Middle Name:


Email Address:


Address:


City, State Zip:


Phone:

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Best time to contact you at home is:


If you are under 18 years of age, can you provide required proof of your eligibility to work?
Yes    No

Have you ever filed an application with us before?
Yes    No    If Yes, give date:

Have you ever been employed with us before?
Yes    No    If Yes, give date:

Do any of your friends or relatives, other than spouse, work here?
Yes    No

Are you currently employed?
Yes    No

May we contact your present employer?
Yes    No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citinzenship or immigration status will be required upon employement.

Yes    No

Date available for work:


What is your desired salary range:


Are you available to work:
Full Time Shift 1
Full Time Shift 2
Full Time Shift 3
Part Time Morning
Part Time Afternoon
Part Time Evenings
Temporary
Dates available for temporary work:

Are you currently on "lay-off" status and subject to recall?
Yes    No

Have you been convicted of a felony within the last five years?
(A criminal record does not constitute an automatic bar to employment and will be considered only as it relates to the job in question.)
Yes    No

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Education

Elementary School - Name & Address:


Elementary School - Course of Study:


Elementary School - Number of Years Completed:


Elementary School - Diploma / Degree:

---

High School - Name & Address:


High School - Course of Study:


High School - Number of Years Completed:


High School - Diploma / Degree:

---

Undergraduate College - Name & Address:


Undergraduate College - Course of Study:


Undergraduate College - Number of Years Completed:


Undergraduate College - Diploma / Degree:

---

Graduate College - Name & Address:


Graduate College - Course of Study:


Graduate College - Number of Years Completed:


Graduate College - Diploma / Degree:

---

Other - Name & Address:


Other - Course of Study:


Other - Number of Years Completed:


Other - Diploma / Degree:


Describe any specialized training, apprenticeship, skills and extra-curricular activities:

Describe any job-related training received in the United States Military:

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Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activites. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

Employer 1


Address:


City, State Zip:


Phone:


Job Title:


Supervisor:


Reason for Leaving:


Employment Dates:
From:

To:


Hourly Rate/Salary:
Start:

Finish:


Work Performed:

---

Employer 2


Address:


City, State Zip:


Phone:


Job Title:


Supervisor:


Reason for Leaving:


Employment Dates:
From:

To:


Hourly Rate/Salary:
Start:

Finish:


Work Performed:

---

Employer 3


Address:


City, State Zip:


Phone:


Job Title:


Supervisor:


Reason for Leaving:


Employment Dates:
From:

To:


Hourly Rate/Salary:
Start:

Finish:


Work Performed:

---

Employer 4


Address:


City, State Zip:


Phone:


Job Title:


Supervisor:


Reason for Leaving:


Employment Dates:
From:

To:


Hourly Rate/Salary:
Start:

Finish:


Work Performed:

---

List professional, trade, business or civic activities and offices held.
(You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status.)

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Additional Information

Other Qualifications:
(Summarize special job-related skills and qualifications acquired from employment or other experiences)


Specialized Skills
Terminal
PC/MAC
Typewriter
Spreadsheet
Word Processing
Production/Mobile Machinery:
Production/Mobile Machinery:
Production/Mobile Machinery:
Production/Mobile Machinery:
Other:
Other:
Other:
Other:

State any additional information you feel may be helpful to us in considering your application:


Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Can you perform the essential functions of the job, for which you are applying, either with or without a reasonable accommodation? Yes    No

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References

Reference 1 Name:


Phone:


Address, City, State Zip:

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Reference 2 Name:


Phone:


Address, City, State Zip:

---

Reference 3 Name:


Phone:


Address, City, State Zip:

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Applicant's Statement

I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

NOTICE: It is Speed Lube's policy that anyone promoted to or hired to be an Assistant Manager or Store Manager, that employment will be probationary pending a clean criminal background.

By checking the following, I agree to the above applicant's statement:
Yes    No