Lone Star Super Wash

Application For Employment

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

Position Applying for:
Type of Employment
Expected Pay
Date available to start
Have you ever worked for Lone Star Super Wash?
Do any of your relatives work (or have worked) for Lone Star Super Wash?
   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?

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

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

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

I understand that Lone Star 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 Lone Star 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 Lone Star 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

Lone Star 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