Reflections Carwash, Inc.

3621 Malcolm Drive

Montgomery, AL. 36116

(334) 272-4667

Application for Employment

I. Complete the following information (please print.) Date: ____________________

Full Name: _____________________________________ Date of Birth______________

Social Security Number: ___________________________

Current Address: _________________________________________________________

City: ____________________________ State: _________ Zip Code: _______________

Length of residence at current address: _______months _______years

Telephone Number: ________________________(Home) ____________________(Cell)

Student: yes___ no___ Location________________________________ Grade________

Date Available for hire: ____________ Number of hours available per week: _________

Shift hours preferred/available for: ___________________________________________

Are you available for weekend work? Y ___ N ___

Do you have your own transportation? Y ___ N ___

II. Work Experience: (Please list your last two, most current employers and the positions you have held at each location. Include job responsibilities, length of employment and why you left that position.)

1.______________________________________________________________________________________________________________________________________________________________________________________________________________________

2.______________________________________________________________________________________________________________________________________________________________________________________________________________________

III. Briefly describe why you think you are the right person for this job:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Reflections Carwash, Inc. is an equal opportunity employer and does not discriminate on the basis of race, religious beliefs, gender, or sexual preferences.