First Name

Last Name

Street Address

City

State StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code

Phone

Email Address

If hired, what date would you be available for work?

If you made the schedule, how many hours per week would you schedule yourself?

Are you seeking: Are you seeking: Part Time Full Time Either

Monday Monday Anytime 7-11 AM 11AM - 4 PM 4 – 8 PM Not Available

Tuesday Tuesday Anytime 7-11 AM 11AM - 4 PM 4 – 8 PM Not Available

Wednesday Wednesday Anytime 7-11 AM 11AM - 4 PM 4 – 8 PM Not Available

Thursday Thursday Anytime 7-11 AM 11AM - 4 PM 4 – 8 PM Not Available

Friday Friday Anytime 7-11 AM 11AM - 4 PM 4 – 8 PM Not Available

Saturday Saturday Anytime 7-11 AM 11AM - 4 PM 4 – 8 PM Not Available

Sunday Sunday Anytime 7-11 AM 11AM - 4 PM 4 – 8 PM Not Available

High School

Course of Study/Degree or Diploma

Did you Graduate? Did you Graduate? Yes No

Business/Trade/Technical

Course of Study/Degree or Diploma

Did you Graduate? Did you Graduate? Yes No

College

Course of Study/Degree or Diploma

Did you Graduate? Did you Graduate? Yes No

May we contact your present employer? May we contact your present employer? Yes No

Company Name

Telephone

Address

Employed From

To

Job Title and duties performed

Supervisor

Reason for Leaving

Company Name

Telephone

Address

Employed From

To

Job Title and duties performed

Supervisor

Reason for Leaving

Company Name

Telephone

Address

Employed From

To

Job Title and duties performed

Supervisor

Reason for Leaving

Experience

Licenses

Certifications

Training

Did you serve in the U.S. Armed Forces? Did you serve in the U.S. Armed Forces? Yes No

Which Branch?

Describe any training received relevant to the position for which you are applying

I understand that I will be required to pass a pre-employment drug screen, and if hired, I will be subject to Floris Car Wash’s drug and alcohol testing policy during my employment.

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby authorize Floris Car Wash to thoroughly investigate my references, work record, education and any other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports, and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers, and all other persons, corporations, partnerships, and associations from any and all claims, demands, or liablities arising out of or in any way related to such investigation or disclosure.

I understand that nothing contained in the application or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the company. In addition, I understand and agree that if I am employed, my employment is "at will" for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the Company's designated representative.

Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien, or outstanding judgement) be conducted by internal personnel employed by the Company, I am entitled to copies of any such public records obtained by the Company unless I mark the check box below. If I am not hired as a results of such information, I am entitled to a copy of any such records even though I have checked the box below.

I waive receipt of a copy of any public records described in the paragraph above. I waive receipt of a copy of any public records described in the paragraph above. I Agree

Date

Applicant's Signature