| First and Last Name |
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| Address |
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| City |
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| State |
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| Zip |
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| Social Security Number |
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| Phone w/Area Code |
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| Email |
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| Are you eighteen or older? |
Yes No
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| Are you presently employed? |
Yes No
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| If yes, what is your current occupation? |
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| Position applying for?
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| Are you applying for full time or part time?
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Full time Part time
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| Date you can start?
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| Desired Weekly Salary |
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| Desired Shop Location |
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| Job References (Last 3 employers. Include name, address, telephone and contact person.) |
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| Do you have dependable transportation? |
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| Would you be opposed to drug testing? |
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| Are you willing to work on weekends or nights? |
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| Any restrictions on work schedules? If so what? |
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| How were you referred to this company?
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| Constant and awkward bending and extended hours on your feet are requirements for this job. Is there anything that would prevent you from doing this? If so, explain. |
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| 5-Minute Oil Change has several locations and positions. Would you be opposed to working permanently or temporarily at another location? How far are you willing to travel? |
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| Please list 2 or 3 personal references with name, address, phone #, relationship, & years known. |
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| Educational Background |
| a. High school information |
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| b. Did you graduate? |
Yes No
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| c. College information |
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| d. Did you graduate? |
Yes No
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| e. Other information. Trade school etc... |
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| Have you ever been convicted of a crime other than traffic violations? If so, describe and explain. |
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| Special skills or training that would help you with this job. |
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| Military Service? |
Yes No
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| If yes, state branch, discharge date, rank at discharge and type of discharge. |
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| Have you ever worked for 5-Minute Oil Change before? If so Where? Reason for leaving? |
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| Any extra comments that you would like to add. |
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Please complete all fields. |
