PERSONAL INFORMATION Name (last, first and middle)

Present address

City

State

ZIP Code

Permanent address (if different)

City

State

ZIP Code

Email address

Phone number

Cell Phone number

Are you 18 years of age or older?
Yes     No

After employment, can you provide proof that you are allowed to work in the US?
Yes     No

EMPLOYMENT DESIRED Position

Date you can start

Salary desired

Available to work
Full time  Part time

Are you employed now?
Yes     No

If yes, may we inquire of your present employer?
Yes     No

Who referred you to our Company?
Have you ever worked for us before?
Yes     No

If yes, where?

If yes, when?

Exact reason(s) for leaving

Name of last supervisor at our Company

FORMER EMPLOYERS
Your last four employers, starting with the most recent
1. Name/Address

Start Date

Final Date

Start Salary

Final Salary

Title/Position

Description of work

Reason for leaving

Termination
Voluntary  Involuntary

Supervisor

May we contact?
Yes No

Phone #



2. Name/Address

Start Date

Final Date

Start Salary

Final Salary

Title/Position

Description of work

Reason for leaving

Termination
Voluntary  Involuntary

Supervisor

May we contact?
Yes No

Phone #



3. Name/Address

Start Date

Final Date

Start Salary

Final Salary

Title/Position

Description of work

Reason for leaving

Termination
Voluntary  Involuntary

Supervisor

May we contact?
Yes No

Phone #



4. Name/Address

Start Date

Final Date

Start Salary

Final Salary

Title/Position

Description of work

Reason for leaving

Termination
Voluntary  Involuntary

Supervisor

May we contact?
Yes No

Phone #

EDUCATION HISTORY High School
Name & Location

# Years Attended

Did you graduate?

Major/Minor Studied


College
Name & Location

# Years Attended

Did you graduate?

Major/Minor Studied


Graduate School
Name & Location

# Years Attended

Did you graduate?

Major/Minor Studied


Trade School
Name & Location

# Years Attended

Did you graduate?

Major/Minor Studied

MILITARY SERVICE Describe any military service skills that may be relevant to the job you are applying for

OTHER SKILLS, QUALITIES OR CHARACTERISTICS Describe any other skills, qualities or characteristics that you possess which would be valuable to Naples Island Car Wash

PERFORMANCE OF JOB-RELATED FUNCTIONS Are you able to perform the essential functions of the job for which you are applying with or without accomodation?
Yes No

CRIMINAL HISTORY
A conviction will not necessarily disqualify an applicant
Have you ever been convicted of a criminal offense (felony or serious misdemeanor)?*
Yes No

If yes, how many times
Explain fully each conviction (and guilty or nolo contendere plea)

REFERENCES
Three people not related to you, that you've known for at least one year
Reference #1
Name

Address

Phone

Business

Years Known


Reference #2
Name

Address

Phone

Business

Years Known


Reference #3
Name

Address

Phone

Business

Years Known

AUTHORIZATION Before sending your questionnaire, please take a moment to make sure you have completed all of the questions. Failure to complete all of the questions may delay or prevent the processing of your questionnaire.

By pressing the button below you are agreeing to all of the following:

I declare under penalty of perjury that the information contained in this questionnaire is true and complete to the best of my knowledge.

I understand that any false information or significant ommissions will disqualify me from further consideration for employment, and will be justification for my dismissal from employment, if discovered at a later date.

I agree to immediately notify the Company if I should be convicted of any crime while my job questionnaire is pending or during my period of employment, if hired.

I give permission for a pre-employment drug screening exam.

I give permission for a complete employment background check.

I consent to the appropriate release of any and all medical information, as may be deemed necessary.

I understand that, if hired, I may be required to sign a company arbitration agreement.

I understand that, if hired, I may not hold other employment unless given permission in writing by the Company.

Agreement for At-Will Employment
I understand and acknowledge that my employment will be at-will, and may be terminated with or without cause, and with or without notice, at any time at the option of myself or the Company. Only the President of the Company has the authority to enter into an employment agreement for a specified period of time or for the termination only for cause, and any such agreement must be in writing. Except to the extent I am covered by such a written agreement, I understand and acknowledge that this constitutes the entire agreement between me and the Company regarding the term of my employment and supercedes any other oral or written agreement.

Compliance With Rules
If I become employed, in consideration of my employment, I understand that I must comply with the rules, regulations, policies and procedures of the Company.

Release
I authorize the investigation of all statements contained in the Pre-Employment Questionnaire form and further authorize any person, school, current employer (except as expressly noted), past employer(s), and organizations named in the Pre-Employment Questionnaire form to provide the Company with records, information, and opinion that may be useful in making a hiring decision. I release all informants from all liability for any damage that may result from furnishing information and opinion (which is truthful or made in good faith) to the Company.



Hours:

Monday 8:30 AM - 5:00 PM
Tuesday CLOSED
Wednesday 8:30 AM - 5:00 PM
Thursday 8:30 AM - 5:00 PM
Friday 8:00 AM - 5:00 PM
Saturday 8:00 AM - 5:00 PM
Sunday 8:00 AM - 5:00 PM