Form

Application for Employment

PLEASE READ THE FOLLOWING BEFORE FILLING OUT THIS APPLICATION.

No question on this application is intended to secure information to be used for a discriminatory purpose. This company is an equal employment opportunity employer and does not discriminate on the basis of race, color, religion, sex, citizenship, national origin, age, disability or veteran status or any other legally protected group.
APPLICANTS STATEMENT OF UNDERSTANDING AND AUTHORIZATION

I understand that this application will be given every consideration, but its receipt does not imply that the applicant will be employed.

I understand and authorize Jerry's Express Car Wash to obtain information through personal interviews with friends, neighbors, and others with who I am acquainted. This interview includes information as to my character, general reputation and personal characteristics. I give my permission to the company to contact any of the former employers or references shown below to verify the information I have given. I authorize previous employers to release all records of my employment including assessments of my job performance ability and fitness.

I understand that the company may require a Motor Vehicle (MVR) Report. I understand that the company reserves the right to require a confidential offer of employment medical examination as well as periodic physical or medical examinations, a pre-employment as well as post-employment drug alcohol test, to the extent permitted by law. I herby state that the information given by me in the application is true in all respects and I agree that if I am employed and the information is found to be false in any respect that I may be dismissed. I understand that I may be required to complete a drug/substance abuse test at company expense. I also understand that all accidents require a drug/substance test as a condition of continued employment.

Should I be employed I understand that such employment will not result in an employment contract for any specific term.
Personal Information
Name: *

First Name Middle Name Last Name
Phone Number: *

- Area Code Phone Number
E-mail Address:
Click to edit
At which locations are you willing to work? *

Golden Triangle Hudson Oaks Garland North Beach Crowley

Present Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Previous Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home or Nearest Telephone Number

- Area Code Phone Number
Emergency Contact Information
Name

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

- Area Code Phone Number
Are you over the Age of 18? If no, Employment is subject to verification that applicant is of minimum age.
Are you authorized to work in the United States?
If a driver license is required for the position for which you are applying, do you have a valid Texas Drivers license?
Are you insurable?
Any restrictions of licenser?
If yes, please explain
Do you hold any other operators permits?
If yes, please explain
Do you hold a commercial driver's license?
Have you ever been convited of a felony, excluding a traffic violation?
If yes, please explain. A conviction does not automatically mean you will not be offered a job. What you were convicted of, the circumstances surrounding the conviction and how long ago the conviction occurred are important. Please give all the facts.
If a drivers license is required for the postion which you are applying, have you ever been convicted of a DWI (Drinking While Intoxicated or Driving Under the Influence) DUI?
If yes, give date(s) and details of each conviction.
If a surety bond is required for the position for which you are applying haave you ever been refused a surety bond?
If yes, give date(s) and details of each conviction.
Employment Availability
Employment Desired
Salary Desired?
How many hours per week are you willing to work?
What position are you applying for?

Car Wash Attendant Site Manager Assistant Manager
Education Job Skills & Training
What is the highest grade level completed in high school?
Did you or are you attending college?
Please select any of the following computer programs of which you are proficient.

Internet Microsoft Word Microsoft Excel Microsoft PowerPoint Facebook YouTube
Please select any of the following skill sets that may apply to you.

Data Entry Graphic Design Salesman Manager Typing Web Design Mechanic
Describe your skills: *
Training or Certifications:
Is this your first job?

Yes No
Upload Resume:
Previous Employment
Previous Employer 1
Company Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Employed From: *

- Month - Day Year
Employed To:

- Month - Day Year
Phone Number

- Area Code Phone Number
Name of Supervisor?
Your reason for leaving this job?
Previous Employer 2
Company Name:

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Employed From: *

- Month - Day Year
Employed To: *

- Month - Day Year
Phone Number

- Area Code Phone Number
Name of Supervisor?

First Name Last Name
Your reason for leaving this job?
References

Please list two (2) people you know well.
Reference 1
Name: *

First Name Last Name
Phone Number *

- Area Code Phone Number
Relationship to you?
Years Known: *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Reference 2
Name: *

First Name Last Name
Phone Number *

- Area Code Phone Number
How were you referred to us? *

Walk-In Employee Newspaper Ad Facebook Twitter Craigslist Other (please specify) Website Drive by Friend
Relationship to you?
Years Known: *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Please provide any additional information here.
If other was selected please explain.
Did you complete this application yourself?

YES NO
Should be Empty:

Personal Information

Emergency Contact Information

Employment Availability

Education Job Skills & Training

Previous Employment

Previous Employer 1

Previous Employer 2

References

Reference 1

Reference 2