Jiffy Lube Future Opportunities Questionnaire

Please complete the form below if you are interested in a position at one of our Jiffy Lube service centers.


Name

First:*  Last:*

Contact Information

Street:* 

City:*  ZIP/Postal Code:* 

Length at this address (months or years): 

Phone:*    Alternate Phone: 

Email:* 

Position Desired*

 Part Time    Full Time  

Alternate Positions Desired 

 Part Time    Full Time  

 Part Time    Full Time  

Have you ever worked for Jiffy Lube before?   Yes

If yes, please tell us where you worked, when (dates) and your position:

Do you have adequate transportation to and from work?  Yes

If your job requires moving motor vehicles, do you have a valid California Drivers License?  Yes

Please list your previous experience and/or employers in order below with present or last experience and/or employer listed first. Please include all periods of time including military service and any period of unemployment.

Last Employer

Address: 

City:    ZIP/Postal Code: 

Phone:   

Position Held:    Name of Supervisor:   

Employment Dates: From:    To:   

Previous Employer

Address: 

City:  ZIP/Postal Code: 

Phone:   

Position Held:    Name of Supervisor:   

Employment Dates: From:    To:   


Additional Training (Automotive, Retail, Management):

  Years Completed:   

Diploma/Degree:    Course of Study:   

Have you ever pled guilty or "no contest" to, or been convicted of, a misdemeanor or felony or been arrested for any matters for which you currently are out on bail or on your own recognizance pending trial?
 Yes

If yes, please give the date(s) and details:: 

NOTE: Answering "Yes" to these questions does not mean you will not be considered for Jiffy Lube opportunities. Things like age, time, seriousness and nature of the offense as well as rehabilitation are taken into account. (Do not include minor traffic infractions, and convictions where the record has been sealed or expunged, any conviction where probation has been successfully completed or otherwise discharged and the case has been judicially dismissed, referrals to and participation in any pre-trial or post trial diversion programs, and marijuana-related offenses that occurred over 2 years ago).

I UNDERSTAND THAT TO BE CONSIDERED FOR EMPLOYMENT, I WILL NEED TO COMPLETE AN EMPLOYMENT APPLICATION FOR JIFFY LUBE. I ALSO UNDERSTAND THAT JIFFY LUBE IS A DRUG-FREE WORKPLACE AND AS A CONDITION OF ANY EMPLOYMENT OFFER, I WILL NEED TO PASS A PRE-EMPLOYMENT DRUG SCREEN AND BACKGROUND CHECK. I CERTIFY THAT ALL OF THE INFORMATION I HAVE PROVIDED IS TRUE.