Application For Employment - Jiffy Lube


It is the policy of this company to provide equal employment opportunities to all qualified persons without
regard to race, creed, color, religious belief, sex, age, national origin, physical or mental handicap or
veteran status. PLEASE PRINT.
POSITION(S) APPLYING FOR: ________________________________________
Date ________________
Name: _______________________________________________________________________________________
Address: ____________________________________________________________________________________
Street and Apt. #
Zip Code
Phone Number: ________________________________
Social Security #: __________________
Driver’s License #: ________________State: ____Expires ___________
How did you hear about this position? ________________________________________________________________
Can you prove you are a U.S. Citizen or otherwise authorized to
Salary Desired? _____________________
work in the United States on an unrestricted basis: Yes ______ No ______
If applicable, please list your visa type, visa # and expiration: ____________________________________
If under 18 years of age, can you furnish a work permit if required? __________ If, not please explain
If hired, are you able to get to work and meet attendance requirements every day? ___________________
Have you been convicted of a felony in the last five years? _______ If so, please explain.
(Conviction does not automatically bar you from employment consideration.)
Type of employment wanted:
Full Time_____ Part Time ____ Temporary ____
Date available for work: ____ What hours do you prefer to work? _________________________________
Can you work overtime, if required? _____ Weekends if required? _____ Please list hours you cannot
work ________________________ Will you relocate if the job requires it? ______
Will you travel if required? _____ How many days of work or school have you missed in the last year for
reasons other than sickness? _____ Please explain:
EDUCATION BACKGROUND Please circle the highest level of education attained.
Elementary Junior High High School G.E.D Technical/Trade School (which field?)
_____________________________________ Military Education ____________________________
College 1 2 3 4 College Name and City _____________________ Graduate School ______________
Are you currently in school? __ What level? ___ Summarize special training or skills that may qualify you


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