FIRST NAME MIDDLE LAST

PRESENT ADDRESS IN FULL CITY STATE ZIP TELEPHONE

PERMANENT ADDRESS (IF DIFFERENT) CITY STATE ZIP TELEPHONE

ARE YOU LEGALLY AUTHORIZED YOUR VISA TYPE IF AVAILABLE VISA # AND EXPIRATION DATE TO WORK IN THE UNITED STATES?

LICENSE NUMBER: __________ STATE: __________ EXPIRATION DATE: _________

IF YES, GIVE FULL PARTICULARS.

(THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT):

_____________________________________________________________________________________________________

LAST HIGH SCHOOL ATTENDED/complete address

COLLEGE OR UNIVERSITY/complete address

MAJOR _______________________________________________ DEGREE RECEIVED _____________________

COLLEGE OR UNIVERSITY/complete address

MAJOR _______________________________________________ DEGREE RECEIVED _____________________

MAJOR _______________________________________________ DEGREE RECEIVED _____________________

IN WHAT LANGUAGES OTHER THAN ENGLISH CAN YOU CONVERSE?

FULL NAME OF COMPANY TELEPHONE CURRENT SALARY -

STREET ADDRESS CITY STATE ZIP CODE

NAME & TITLE OF SUPERVISOR

TITLE OF YOUR POSITION DEPARTMENT

DUTIES

REASON FOR LEAVING EMPLOYMENT START DATE END DATE

FULL NAME OF COMPANY TELEPHONE SALARY -

STREET ADDRESS CITY STATE ZIP CODE

NAME & TITLE OF SUPERVISOR

TITLE OF YOUR POSITION DEPARTMENT

DUTIES

REASON FOR LEAVING EMPLOYMENT START DATE END DATE

FULL NAME OF COMPANY TELEPHONE SALARY - BEGIN/END FROM/TO

STREET ADDRESS CITY STATE ZIP CODE

NAME & TITLE OF SUPERVISOR

TITLE OF YOUR POSITION DEPARTMENT

DUTIES

REASON FOR LEAVING EMPLOYMENT START DATE END DATE

LIST PART-TIME EMPLOYMENT WHILE IN SCHOOL, INCLUDING COMPANY NAME(S), ADDRESSES, DATES OF EMPLOYMENT:

HAVE YOU EVER BEEN SUSPENDED, PLACED ON PROBATION, ASKED TO RESIGN, DISCHARGED. OR

IF YES, PLEASE EXPLAIN:

______________________________________________________________________________________________________

TYPING SPEED (WORDS/MINUTE) ____________

INDICATE EXPERIENCE IN YEARS AND MONTHS FOR EACH AREA:

ACCOUNTING ____________ BOOKKEEPING____________ COMPUTER____________

PAYROLL____________ ADDING MACHINE____________ STATISTICS ____________

LIST ANY OTHER SKILLS YOU THINK MAY BE OF VALUE TO THE COMPANY, SUCH AS PROGRAMMING, ETC.

___________________________________________________________________________________________________

BRANCH OF SERVICE (IF NONE, STATE NONE): ____________________

MILITARY OCCUPATION: _____________________________________

DATE OF ENTRY INTO ACTIVE DUTY: __________/__________ DATE OF SEPARATION: __________/_________

(MONTH/YEAR) (MONTH/YEAR)

RANK AT THE TIME OF SEPARATION: _____________________

PLEASE NOTE: FINAL PROCESSING PRIOR TO EMPLOYMENT WILL REQUIRE A REVIEW OF THE ORIGINAL OR A COPY OF YOUR MILITARY DISCHARGE AND/OR A REVIEW OF YOUR DD FORM 214.

I HEREBY CERTIFY that my answers to the foregoing questions are true and complete and that I have not knowingly withheld any facts, circumstances or other information which would, if disclosed, affect my application. I further understand that any false or misleading statement or omission of pertinent information will result in the rejection of my application, or in dismissal if discovered subsequent to my employment.

I HEREBY AFFIRM that by execution of the application, I acknowledge that the Company has disclosed to me that an Investigative Consumer Report, including information as to my character, general reputation, personal characteristics, and mode of living may be made; and that I, upon written request to the Company made within a reasonable time after the date of this application, may obtain a complete and accurate disclosure of the nature and scope of the investigation requested.

I HEREBY AUTHORIZE the Company to request, and I ALSO AUTHORIZE AND REQUEST each former employer, school attended, and each person, firm, or corporation given as references above, to furnish at any time, any information which may be sought concerning me and my work habits, character or skill, and any other data required, whether in connection with this application or for purposes of complying with surety company requirements or otherwise.

I HEREBY AFFIRM that by submitting this application I agree to submit to medical evaluations and/or examinations, including tests for the presence of illegal drugs or alcohol, prior to and during employment, within a time period prescribed by the Company and as often as directed during employment.

I HEREBY AUTHORIZE the medical examiner to disclose to the Company any and all findings and conclusions arrived at in any examination performed either prior to employment or during employment.

I UNDERSTAND that should I be given employment, such employment shall be for an indefinite period of time and may be terminated, at will, at anytime, for any reason, by me or by the Company without notice or without liability whatsoever, except for unpaid wages or salary earned by the date of termination. I further understand that only the CEO/President of the Company has the authority to enter into any agreement for employment for a specified period of time or to make any agreement contrary to this at will standard and that any such agreement must be in writing.

I UNDERSTAND that if I am employed, the terms and conditions of my employment will be governed by this application and the Company's Terms of Employment and Policy and Procedures, as amended from time to time by the Company.

The Company operates under the principles of affording equal employment opportunity through affirmative action for qualified handicapped individuals, qualified veterans of the Vietnam era and qualified disabled veterans.

All applicants and employees who believe themselves to be members of one or more of these groups, and who wish to identify themselves as such for the purpose of affirmative action consideration are invited to do so.

Submission of this information is voluntary and refusal to provide it will not subject you to discharge or disciplinary treatment. Information obtained concerning individuals shall be kept confidential, except that (1) supervisors and managers may be informed regarding disabled veterans and handicapped individuals, as necessary, (2) first aid and safety personnel may be informed, when and to the extent appropriate, if the condition might require emergency treatment, and (3) governmental officials investigating compliance will be informed.

Thank you for completing this application. It will remain under consideration for six months. It will not be necessary for you to reapply during this six month period. Your interest in Elegant AutoWash, Inc is appreciated.