Personal Information
    First Name*
    Middle Name
    Last Name*
    Email*
    Phone*
    Address*
    City*
    State/Province*
    Zip*
    Are you at least 18 years old?*
    Are you eligible for employment in this country?* Proof of employability will be required of all applicants hired.
    Availability
    What date would you be available to begin work?*
    Full or part time?*
    Are you employed now?*
    For each day below, please indicate the hours from 7:45AM to 5:15PM you would be able to work. (Some locations until 5:45PM.)*
    Monday*
    Tuesday*
    Wednesday*
    Thursday*
    Friday*
    Saturday*
    Employment History
    List below your last three employers, starting with your most recent employer.
    Employer 1
    Company Name*
    Reason for leaving
    State job title
    Employer 2
    Company Name*
    Reason for leaving
    State job title
    Applicant Statement

    I certify that all information I have provided in order to apply for and secure work with the employer is true and correct.

    I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (1) cancel further consideration of this application, or (2) immediately discharge me from the employer's service, whenever it is discovered.

    I expressly authorize, without reservation, the employer, its representative, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

    I understand this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

    If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's Chairman of the Board.

    DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.
    I certify that I have read, fully understand, and accept all terms of the foregoing Applicant Statement.*
    Date*
    Prompto 10 Minute Oil Change

    If you are hired to work at Prompto 10 Minute Oil Change, your job will require you to be able to perform the following essential functions. To ensure your health and safety, as well as that of our other employees and our customers and vendors, and to ensure you can properly perform your duties, please review the functions below and confirm by signing this form that you are able to perform these functions. If you are unable to perform any of these functions, please describe below what you are unable to do. DO NOT DESCRIBE ANY PARTICULAR ILLNESS YOU MAY HAVE, JUST DESCRIBE WHAT YOU ARE UNABLE TO DO.

    1. Repetitive bending down, squatting down, and stooping.

    2. Lift up to 50 pounds to your waist level and carry it across a room. The heaviest thing you will usually pick up is a six (6) gallon case of washer fluid or antifreeze. These items weigh approximately 50 pounds. NEVER TRY TO CARRY TWO CASES OR ANYTHING AT THE SAME TIME. IF YOU ARE UNSURE OF THE WEIGHT OF AN ITEM, ASK THE STORE MANAGER BEFORE TRYING TO LIFT IT.

    3. Utilize both hands, wrists and arms, sometimes at the same time, to perform mechanical repairs such as screwing a bolt or oil filter on or off, repetitively.

    4. Go up and down a short (5 to 10 steps) flight of stairs.

    5. Be on your feet for up to four hours straight.

    6. Communicate clearly to co-workers as well as customers.

    To the best of my knowledge, I am able to perform the above essential functions of any job at Prompto 10 Minute Oil Change, except as noted below.

    I have the following limitations regarding the above essential job functions:
    Signature*
    Date*
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