Application for Employment Personal InformationName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* If hired, can you furnish proof of age?*YesNoIf hired, can you furnish proof that you are legally entitled to work in the US?*YesNoAre you willing to take a drug screening test for illegal drugs and/or narcotics?*YesNoWork AvailabilityPosition you are applying for* Tune Up Mechanic Lube Technician Other Date you are available to start work* Are you available for full time or part time work?*Full TimePart TimeTotal hours available per week*What hours are you available to work each day?*(Please list start and stop times for each day)Monday: Tuesday: Wednesday: Thursday: Friday: Saturday: During the past year, have you ever been convicted of a crime involving dishonesty, violence or illegal drugs?*YesNoEducationName & location of high school(s) attendedDid you graduate from high school?YesNoName & location of college(s) attendedDid you graduate from college?YesNoCollege major/degreeOther education (name & type)Work Experience1a) Company name, address & phone1b) Start & end date (month/year)1c) Rate of pay (starting & final)1d) Supervisor & reason for leaving2a) Company name, address & phone2b) Start & end date (month/year)2c) Rate of pay (starting & final)2d) Supervisor & reason for leaving3a) Company name, address & phone3b) Start & end date (month/year)3c) Rate of pay (starting & final)3d) Supervisor & reason for leaving4a) Company name, address & phone4b) Start & end date (month/year)4c) Rate of pay (starting & final)4d) Supervisor & reason for leavingApplicant Signature*I certify that the information provided in this application is true and correct. I understand that any omission or misstatement is grounds for dismissal. Entering my name below serves as my signature.Application Date* PhoneThis field is for validation purposes and should be left unchanged.