EZLUBE APPLICATION FORM

Click Here for Printable Application Form
Complete form and drop off at any EZ Lube Location

  
 
EQUAL EMPLOYMENT OPPORTUNITY DATA
Completion of this form is entirely voluntary, and all information will remain confidential and will not affect your application for employment. We are required by law to collect this information for equal opportunity employment purposes, and it will not become part of your personnel record if this company hires you.
 
     
Name:  
Gender:  
Male Female
Race/Ethnicity:  
American Indian/Alaskan Native
Asian
Black or African-American
Hispanic or Latino
White
Native Hawaiian or other Pacific Islander
Two or more races
Store Location of Interest:  

Government contractors must take affirmative action to employ and advance certain qualified individuals subject to the Rehabilitation Act of 1973 and the Vietnam Era Veterans Readjustment Act of 1974. Completion of the following information is voluntary, and will assist us in proper placement and reasonable accommodation. If you wish to be identified as qualifying for such placement or accommodation, please check where applicable.
 
Vietnam Era Veteran     Disabled Veteran     Individual with a Disability
 
 
EZ LUBE, INC.
EMPLOYMENT APPLICATION
Store #:
Answer all questions completely in your handwriting in ink. We are an Equal Opportunity Employer. No question on this application is intended to be discriminatory under any applicable Federal, State or Local Fair Employment Practices Law.
I. PERSONAL INFORMATION
Last Name:
First:
Middle:
Date:
Street Address:  
Home Phone :
City :
State :
Zip :
Cell Phone:
Social Security Number:
Email Address:
Have you ever been involuntarily terminated or requested to resign?
Yes No
If hired, can you provide verification of your legal right to work in the United States?
Yes No
If you are under age 18, do you have a work permit?
Yes No
Driver's license number :
Expiration Date:
If hired, would you have reliable transportation to and from work?
Yes No
Have you ever worked under a different name?
Yes No
If Yes Name:
Do you have friends or relatives working for our company?
Yes No
If Yes Name: Relationship:
  Have you ever worked at EZ Lube before?    Yes      No
Have you ever been convicted of a criminal offense (felony or serious misdemeanor)? (Convictions for marijuana-related offenses that are more than two years need not be listed) (convictions will not necessarily disqualify you for the position)
Yes   No

If Yes
List offense:
 Date:
 Disposition of the Case:
II. EMPLOYMENT INTERESTS
Position Desired :
Date Available:
Hourly Rate Desired :
Would you be willing to work overtime :
Yes        No
Type of Employment Desired
Regular Full-Time
Temporary Part-Time
Days and hours available for work
 
How were you referred to our company? Ad (where) Employee Referral (Name)
Agency (Name) Other (Please specify) Walk-in
         
III. EDUCATION INFORMATION
School Level
Name and Location of School
Course of Study
Degree or Diploma
High School
College/University
Business/Trade Technical
IV. SKILLS
Computer Skills:
Yes No
Foreign Languages (indicate proficiency to speak, read and write)
Can you perform the essential duties of the position for which you are applying?
Yes No
No If no, please explain. (If you have any question as to what functions are applicable to the position for which you are applying, please ask the interviewer before you answer this question.
  
 
 
Do you have any experience, training, qualifications or special skills, which you think, make you especially suited for work at this company? (Explain)
 
V. EMPLOYMENT INFORMATION (Start with Current or Most Recent Employer)
1
Company Name :
Phone :
From Mo./Yr. :
To Mo./Yr. :
 
Street Address
City :
State :
Zip :
Starting Pay$ :
Ending Pay$ :
 
Job Title :
Duties :
Reason for leaving :
    Supervisor’s Name :
May we contact this employer?
Yes No
2
Company Name :
Phone :
From Mo./Yr. :
To Mo./Yr. :
 
Street Address :
City :
State :
Zip :
Starting Pay$ :
Ending Pay$ :
 
Job Title :
Duties :
Reason for leaving :
    Supervisor’s Name :
May we contact this employer?
Yes No
3
Company Name :
Phone :
From Mo./Yr. :
To Mo./Yr. :
 
Street Address
City :
State :
Zip :
Starting Pay$ :
Ending Pay$ :
 
Job Title :
Duties :
Reason for leaving :
    Supervisor’s Name :
 
May we contact this employer?
Yes No
Initial
I authorize any person, school, current employer (except as expressly noted), past employer(s), and organizations named in this application form (and accompanying resume or other documentation, if any) to provide the Company with relevant information and opinion, personal or otherwise, that may be useful in making a hiring decision. I release all parties from all liability for any damage that may result from furnishing information and opinion to you.
Initial
In consideration of employment, I agree to obey the rules and standards of the Company. I understand that nothing contained in this application or in the interview process is intended to create a contract between the Company and myself for either employment or for the providing of any benefits. I agree that my employment is at-will and the terms of employment may be changed with or without cause, with or without notice, including but not limited to termination, demotion, promotion, transfer, compensation, benefits, duties and location of work, at any time, for any reason, at the option of myself or the Company. This constitutes my entire agreement with the Company with regard to the length of my employment.
Initial
I understand that as a condition of employment I will be required to take a pre-employment drug test. I further understand if injured on the job, I will be required to take a drug test. I may be required to take a drug/alcohol test if management reasonably suspects a condition exists that will prevent me from performing my job in a manner that may endanger my own health or the safety and health of others. I authorize all providers of health care who examine me to disclose to the Company or its agents, all medical information revealed during such examinations. I further authorize the Company to disclose such information to any other persons; if at any time my medical condition is put at issue in any proceeding by others or myself.
Initial
I understand that I must notify management, in writing, of any special accommodations I may need to perform the job. The company may choose to have a report submitted from my physician of my limitations.
Initial
I understand that all offers of employment are conditioned upon my providing satisfactory documentary proof of my identity and legal right to live and work in the United States.
Initial
I hereby acknowledge that I have read the above statements and understand them. I certify that I, the undersigned applicant, have personally completed this application. I declare under penalty of perjury that the facts contained in the application (or any resume or other documents submitted) are true and complete to the best of my knowledge. I understand that any misrepresentations or omissions will disqualify me from further consideration for employment, and will be justification for my dismissal from employment, if discovered at a later date.
VI. ACKNOWLEDGMENT
Please read carefully, initial each paragraph, and sign below
Applicant Signature:
Title :
Date: