Please fill out application in full.
F.L. Roberts Employment Application

*First Name
*Last Name
Email
Street Address
Address 2
City
State	Zip
Phone
Other Phone
Best time to call:
How did you hear about us?
Are you over 18 years of age?	Yes No
Do you prefer	Full Time Part Time Temporary

Positions Applied For
Check ALL positions you are interested in (you may choose more than one).

Jiffy Lube
Lube Technician
Manager/Management

Golden Nozzle Car Wash
Customer Service Advisor/Cashier
Full Serve Production Worker
Management

Convenience Store/Gas Station
Cashier
Manager/Management

Employment Data
What days, hours or shifts would you prefer to work?
What days, hours or shifts would you be unable to work?
Have you ever worked for this organization before?	Yes No
List any friends or relatives employed by F.L. Roberts
Work History Please list your last 3 employers beginning with your current or most recent employer. You may include military service and any verifiable work performed on a volunteer basis:

Company Name & Address 3
Your job title
Your job duties
Dates of employment	from to
Starting salary
Ending salary
Supervisor Name
His or Her Title
Supervisor Phone
Specific Reason for Leaving
May we contact the employers listed above? If no, tell us which one(s) you do not wish us to contact and why.	Yes No
Upload Resume Please upload as .doc, .txt, .rtf or .pdf

*Required Field