Application For Employment

Last Name
First Name
Middle Initial
Phone #
Email
Address
City
State
Zip Code

Position Applying for:
Type of Employment ---Part-timeFull-time
Expected Pay
Date available to start
Have you ever worked for Splash & Dash Car Wash? ---NoYes
Do any of your relatives work (or have worked) for Splash & Dash Car Wash? ---NoYes
   If yes, Name of relative:
Relationship

Education

Grammar School
Name of School:
Address:
Last Year Completed:
Last Year Attended:
Major:

High School
Name of School:
Address:
Last Year Completed:
Last Year Attended:
Major:

College/Tech School
Name of School:
Address:
Last Year Completed:
Last Year Attended:
Major:

Graduate
Name of School:
Address:
Last Year Completed:
Last Year Attended:
Major:

Membership in professional or civic organization. (Exclude any that may disclose your race, religion, or national origin):

Employment History

List entire employment history, with the most current employer first.

Employer 1
Address
Phone #
Dates Employed
Supervisor
Rate of Pay
(Starting)
(Ending)
Job Title
Description of Work
Reason for Leaving
May We Contact? ---YesNo

Employer 2
Address
Phone #
Dates Employed
Supervisor
Rate of Pay
(Starting)
(Ending)
Job Title
Description of Work
Reason for Leaving
May We Contact? ---YesNo

Employer 3
Address
Phone #
Dates Employed
Supervisor
Rate of Pay
(Starting)
(Ending)
Job Title
Description of Work
Reason for Leaving
May We Contact? ---YesNo

Personal References

List three people that are not related to you that we may contact for a reference.

1. Name
Address
Phone
Occupation
Number of years known

2. Name
Address
Phone
Occupation
Number of years known

3. Name
Address
Phone
Occupation
Number of years known

Have you ever been discharged by any company? ---YesNo
    If yes, explain:
Have you ever been convicted of a crime (excluding minor traffic citations)? ---YesNo
    If yes, explain:
Are you legally eligible for employment in the U.S.? ---YesNo
Are you of legal age to work in the U.S.? ---YesNo
Do you have any kind of medical condition that might prevent you from performing the job in which you are applying? ---YesNo
    If yes, explain:

I understand that Splash & Dash Car Wash has a commitment to maintain an alcohol/drug-free workplace and requires a drug screening test as part of its selection and hiring process. I further understand and agree that if I am employed, I may be required to submit to alcohol/drug testing under certain circumstances during my employment. Initial here

I hereby authorize Splash & Dash Car Wash and/or its agents to make an independent investigation of my background, references, character, past employment, education, credit history, criminal or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for employment.
I release Splash & Dash Car Wash and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims or law suits in regards to the information obtained from any and all of the above referenced sources used.
The following is my true and complete legal name and all information is true and correct to the best of my knowledge. I agree that false or omitted information may disqualify me for employment with this company. If falsification is discovered at a later date once employed, I understand it may be grounds for dismissal. Initial here

Splash & Dash Car Wash is an Equal Opportunity Employer, and does not discriminate of the basis of Sex, Race, Color, Religion, Age, Disability, Veteran Status or National Origin.

Electronic Signature
Date

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