First Name: Last Name: Middle Initial: Social Security #: Current Address: City: State: Zip: Home Phone: Work Phone:
Are you at least 18 years of age? Yes: No: If no, are you at least 16 years of age? Yes: No:
Position for which you are applying: Expected wage: Date you can start: Have you ever worked at Grease Monkey? Yes: No: If yes which location? When?
Highest grade completed: 78910111213141516+ High School Attended: City State College Attended: City State Degree Business, Vocational, or Other Training: City State Subjects Studied
If the job requires, do you have a valid driver's license? Yes: No: License # Type State Please list any other skills, licenses or certificates that may be job-related or of value to this position.
List states and counties of residence for the past seven years.
Have you used any name or Social Security Numbers other than those above? Yes: No: If so, please list:
Have you been convicted of any law violation (except a minor traffic violation)? Yes: No: If so, please describe below. (In accordance with company policy, this information will be reviewed for job-relatedness and time since last conviction.) Incident City State Charge
Do you have near-relatives employed by Grease Monkey (spouse, parents, children, siblings, step-relatives, in-laws)? Yes: No: If yes, please give their names:
Name of most recent employer: City State Phone Are you currently working for this employer? Yes: No: If so may we contact? Yes: No: Dates Employed Job title: Supervisor: Duties: Salary/Wage per: hour week year Reason for leaving:
Name of second most recent employer: City State Phone Dates Employed Job title: Supervisor: Duties: Salary/Wage per: hour week year Reason for leaving:
Name of third most recent employer: City State Phone Dates Employed Job title: Supervisor: Duties: Salary/Wage per: hour week year Reason for leaving:
Include only individuals familiar with your work ability. Do not include relatives.
Name: Phone Number: Years known: Relationship
I certify that the information and answers given by me to the foregoing questions and the statements made by me are complete and true. I understand that any false information, omissions or misrepresentations of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I authorize the Company and / or its agents, including consumer reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I authorize, whether listed or not, any person, school, company and law enforcement authority to release any information concerning my background and hereby release any said persons, schools, company and law enforcement authorities form any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment. I understand that if am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying. I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINE PERIOD OF TIME IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE. I HAVE READ, UNDERSTAND, AND CONSENT TO THESE STATEMENTS.
