10560 Lincoln Hwy, Irwin, PA 15642
724.863.5560

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Employment Application

Apply for a job at Ron Palarino’s Steel City Car Wash below

PERSONAL INFORMATION

Full Name

Social Security Number

Email Address

Phone Number

Present Address

Permanent Address

Are you 18 Years or Older?

Yes No

Are you prevented from lawfully becoming employed in this country because of visa or immigration status?

Yes No

EMPLOYMENT DESIRED

Position

Date you can start

Salary Desired

Are you employed now?

Yes No

If so, may we inquire of your present employer?

Yes No

Have you ever applied to this company before?

Yes No

Applied Before Where?

Applied Before When

Referred By?

EDUCATION

GRAMMAR SCHOOL

Grammar School Name

Grammar School Location

Grammar School # of Years Attended

Grammar School Subjects Studied

Did you Graduate Grammar School?

Yes No

HIGH SCHOOL

High School School Name

High School Location

High School # of Years Attended

High School Subjects Studied

Did you Graduate High School?

Yes No

COLLEGE

College School Name

College Location

College # of Years Attended

College Subjects Studied

Did you Graduate College?

Yes No

GENERAL

Subjects of Special Study or Research Work

Special Skills

Activities (Civic, Athletic, Etc...)

U.S. Military or Naval Service

Military Rank

Present Membership in National Guard or Reserves

FORMER EMPLOYERS
(List below last three employers, starting with the last one first).

Employer #1 Name

Employer #1 Address

Employer #1 Salary

Employer #1 Position

Employer #1 Reason Left

Employer #2 Name

Employer #2 Address

Employer #2 Salary

Employer #2 Position

Employer #2 Reason Left

Employer #3 Name

Employer #3 Address

Employer #3 Salary

Employer #3 Position

Employer #3 Reason Left

Which of these jobs did you like best?

What did you like most about this job?

REFERENCES
Give the names of three persons not related to you, whom you have known at least one year.

Reference #1 Name

Reference #1 Address

Reference #1 Business

Reference #1 Years Acquainted

Reference #2 Name

Reference #2 Address

Reference #2 Business

Reference #2 Years Acquainted

Reference #3 Name

Reference #3 Address

Reference #3 Business

Reference #3 Years Acquainted

FOLLOW-UP APPLICATION

Please check the days you can work. (Keep in mind you may not be called if you are not able to work at least 3-4 days a week)

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

Please state what times you are available:

How many hours per week are you looking for?

How many days a week requested?

Are you over 18?

Yes No

If under 18, how old?

Choose Position you prefer:

Wash Attendant Cashier

On busy days working conditions become very fast paced with little break. You would be required to move very quickly. Would you be able to keep up with these conditions?

Yes No

On various days the temperature becomes extremely cold, are you able to work in extreme cold weather?

Yes No

By hiring you, what can you offer to our business?

Are you able to work evenings until 7PM?

Yes No

Are you able to work weekends?

Yes No

What transportation would you use to get to work?

Will you be working another job at the same time?

Yes No

Knowing that times can change, how long do you think your estimated employment would be?

Summer Only Until Graduation Winnter Only Unlimited

DIGITAL SIGNATURE AGREEMENT
By agreeing to the terms you are digitaly signing your name to this application.

Agreement (check box below)

I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time.
In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than it's preident, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing."

This form has been revised to comply with the provisions of the Americans with Disabilities Act and the final regulations and interpretive guidance promulgated by the EEOC on July 26, 1991.

724.863.5560
10560 Lincoln Hwy
Irwin, PA 15642

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