Employee Application – Xpress Lube Service Center

Date

Last Name

First Name

Middle Initial

Present Address

Street Address

City

State

Zip Code

Permanent Address Different than Present Address?

Yes No

Business Phone

Home Phone

Email Address

Employment Desired

Position Applying For

Regular Full-Time Work

Yes No

Regular Part-Time Work

Yes No

Temporary work (e.g, summer or holiday work)

Yes No

Other than time off for reasons related to your religion, a disability or a medical condition, are there any days or times when you are unavailable to work?

Would you be able to work overtime, if necessary?

Yes No

If hired, what date can you start work?

Personal Information

How did you hear about our company and this job opening?

Have you ever applied to or worked for Xpress Lube Service Center before?

Yes No

Why are you applying for work at LUBE PIT STOP, INC.?

If hired, would you have a reliable means of transportation to and from work?

Yes No

Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum legal age.)

Yes No

Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?

Yes No

Education, Training, and Experience

What Education, Training, and Experience Will Be Entered?

High School College/University Vocational/Business Automotive Training

Do you have any other experience, training, qualifications, or skills that you feel make you especially suited for work at Xpress Lube Service Center?

Yes No

Answer the following questions if you are applying for a professional position:

Are you licensed/certified for the job applied for?

Yes No

Has your license/certification ever been revoked or suspended?

Yes No

Employment History

List below all present and past employment starting with your most recent employer (last five years is sufficient). Account for all periods of unemployment. You must complete this section even if attaching a resume.

Number of Present/Previous Employers?

References

List below three persons not related to you who have knowledge of your work performance within the last three years.

Number of References?

Please Read Carefully, Initial Each Paragraph and Sign Below

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby authorize Xpress Lube Service Center to thoroughly investigate my references, work record, education and other matters related to my suitability for employment (excluding criminal background information) unless otherwise specified above. I further authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the Company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the Company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the Company's designated representative.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

The Company will consider qualified applicants, including those with criminal histories, in a manner consistent with state and local "Fair Chance" laws.

Date

Applicant Signature

By putting your full name in this box you have agreed that the above information is correct.

Employee Application
An Equal Opportunity Employer

Employment Desired

Personal Information

Education, Training, and Experience

Employment History

References

Please Read Carefully, Initial Each Paragraph and Sign Below

Xpress Lube Service Center

Careers

our locations

Corporate info

We are part of a used oil recycling program

Motor Oil Matters

Employee ApplicationAn Equal Opportunity Employer

Employment Desired

Personal Information

Education, Training, and Experience

Employment History

References

Please Read Carefully, Initial Each Paragraph and Sign Below

Xpress Lube Service Center

Careers

our locations

Corporate info

We are part of a used oil recycling program

Motor Oil Matters

Employee Application
An Equal Opportunity Employer