Application Date (Month, Day, Year):
First: M.I.:
Name Last:
Home Address
Zipcode
Street State
City
Cell Phone
Other Phone
E-Mail Address
How were you referred? (please check one):
Craigslist Employee
Walk-In
Newspaper Ad
Other
If other, please specify:
If referred by an Shield System Employee, please state name of Employee:
Are you interested in (Check all that apply):
Full Time
Temporary
Part Time
Indicate the position applying for:
Indicate the Wash Location(s)
Check all that apply
Check all that apply
Management:
Car Wash Service Advisor
Billerica 455 Boston Road
Brighton 365 Western Ave
Detailer
Winchester 783 Main Street
Maintenance Crew
Are there any days or times you are not available to work? Yes No
If yes, please explain:
Are you currently employed?
Yes No
Employer Name: Employer Address:
Employer Phone: Starting Date of Employment
Final Wage:
Starting Wage:
Reason for Leaving?
May we contact you at work?
Yes No
May we contact your present employer? Yes No
Additional Information:
Yes No
Are you legally entitled to work in the United States?
If you are hired, you will be required to submit proof of legal right to work in the U.S.
Were you ever discharged by any company? Yes No
Have you ever been convicted of a crime
Yes No
If yes, any felony convictions in the last five years? Yes No
Education
Check Highest Completed:
12
9 10 11
High School (Grade)
4+
1 2 3
Technical/Vocational (Years)
Yes No
Completion of Undergraduate degree program:
If yes, specify degree:
State
City
School Name
# of credits taken
Yes
Some College
Work History:
Have you previously been employed by the Shield System Car Wash? Yes No
Do you have relatives employed by Shield System?
Yes No
Starting with most recent employer, please list every job you have held during the
Work Reference #1
Employer Name:
Employer Address:
To:
Dates Employed: From:
Job Title:
Employer Phone:
Supervisor Name:
Starting Wage:
Final Wage:
Reason for Leaving?
Work Reference #2
Employer Name:
Employer Address:
To:
Dates Employed: From:
Job Title:
Employer Phone:
Supervisor Name:
Starting Wage:
Final Wage:
Reason for Leaving?
I have read and agree to the Boston Car Washing Group, Inc. agreement for application of employment
I agree
