DESIRED POSITION
What position are you applying for?*
Full Service Car Wash Attendant
Express Wash Attendant
Quick Lube Attendant
Detailer
Cashier
Manager
Which location do you prefer?*
Chesterfield
Chester
Colonial Heights
Glen Allen
West End
PERSONAL INFORMATION
Title
DR
MISS
MR
MRS
MS
First Name*
Last Name*
Email Address*
Home Address*
City*
State*
Zipcode*
Country*
-- Select Country --
AFGHANISTAN
ALAND ISLANDS
ALBANIA
ALGERIA
AMERICAN SAMOA
ANDORRA
ANGOLA
ANGUILLA
ANTARCTICA
ANTIGUA AND BARBUDA
ARGENTINA
ARMENIA
ARUBA
AUSTRALIA
AUSTRIA
AZERBAIJAN
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BOSNIA AND HERZEGOVINA
BOTSWANA
BOUVET ISLAND
BRAZIL
BRITISH INDIAN OCEAN TERRITORY
BRUNEI DARUSSALAM
BULGARIA
BURKINA FASO
BURUNDI
CAMBODIA
CAMEROON
CANADA
CAPE VERDE
CâTE D'IVOIRE
CAYMAN ISLANDS
CENTRAL AFRICAN REPUBLIC
CHAD
CHILE
CHINA
CHRISTMAS ISLAND
COCOS (KEELING) ISLANDS
COLOMBIA
COMOROS
CONGO
CONGO, THE DEMOCRATIC REPUBLIC OF THE
COOK ISLANDS
COSTA RICA
CROATIA
CUBA
CYPRUS
CZECH REPUBLIC
DENMARK
DJIBOUTI
DOMINICA
DOMINICAN REPUBLIC
ECUADOR
EGYPT
EL SALVADOR
EQUATORIAL GUINEA
ERITREA
ESTONIA
ETHIOPIA
FALKLAND ISLANDS (MALVINAS)
FAROE ISLANDS
FIJI
FINLAND
FRANCE
FRENCH GUIANA
FRENCH POLYNESIA
FRENCH SOUTHERN TERRITORIES
GABON
GAMBIA
GEORGIA
GERMANY
GHANA
GIBRALTAR
GREECE
GREENLAND
GRENADA
GUADELOUPE
GUAM
GUATEMALA
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HEARD ISLAND AND MCDONALD ISLANDS
HOLY SEE (VATICAN CITY STATE)
HONDURAS
HONG KONG
HUNGARY
ICELAND
INDIA
INDONESIA
IRAN, ISLAMIC REPUBLIC OF
IRAQ
IRELAND
ISRAEL
ITALY
JAMAICA
JAPAN
JORDAN
KAZAKHSTAN
KENYA
KIRIBATI
KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF
KOREA, REPUBLIC OF
KUWAIT
KYRGYZSTAN
LAO PEOPLE'S DEMOCRATIC REPUBLIC
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYAN ARAB JAMAHIRIYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAO
MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF
MADAGASCAR
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MARSHALL ISLANDS
MARTINIQUE
MAURITANIA
MAURITIUS
MAYOTTE
MEXICO
MICRONESIA, FEDERATED STATES OF
MOLDOVA, REPUBLIC OF
MONACO
MONGOLIA
MONTSERRAT
MOROCCO
MOZAMBIQUE
MYANMAR
NAMIBIA
NAURU
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NEW CALEDONIA
NEW ZEALAND
NICARAGUA
NIGER
NIGERIA
NIUE
NORFOLK ISLAND
NORTHERN MARIANA ISLANDS
NORWAY
OMAN
PAKISTAN
PALAU
PALESTINIAN TERRITORY, OCCUPIED
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
PITCAIRN
POLAND
PORTUGAL
PUERTO RICO
QATAR
REUNION
ROMANIA
RUSSIAN FEDERATION
RWANDA
SAINT HELENA
SAINT KITTS AND NEVIS
SAINT LUCIA
SAINT PIERRE AND MIQUELON
SAINT VINCENT AND THE GRENADINES
SAMOA
SAN MARINO
SAO TOME AND PRINCIPE
SAUDI ARABIA
SENEGAL
SERBIA AND MONTENEGRO
SEYCHELLES
SIERRA LEONE
SINGAPORE
SLOVAKIA
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS
SPAIN
SRI LANKA
SUDAN
SURINAME
SVALBARD AND JAN MAYEN
SWAZILAND
SWEDEN
SWITZERLAND
SYRIAN ARAB REPUBLIC
TAIWAN, PROVINCE OF CHINA
TAJIKISTAN
TANZANIA, UNITED REPUBLIC OF
THAILAND
TIMOR-LESTE
TOGO
TOKELAU
TONGA
TRINIDAD AND TOBAGO
TUNISIA
TURKEY
TURKMENISTAN
TURKS AND CAICOS ISLANDS
TUVALU
UGANDA
UKRAINE
UNITED ARAB EMIRATES
UNITED KINGDOM
UNITED STATES
UNITED STATES MINOR OUTLYING ISLANDS
URUGUAY
UZBEKISTAN
VANUATU
VENEZUELA
VIETNAM
VIRGIN ISLANDS, BRITISH
VIRGIN ISLANDS, U.S.
WALLIS AND FUTUNA
WESTERN SAHARA
YEMEN
ZAMBIA
ZIMBABWE
Home Phone Number*
Have you ever worked at Flagstop?
Yes No
If YES, when?
Position held:
Have you ever applied at Flagstop before?
Yes No
If YES, when?
Can your present employer be contacted?
Yes No
Do you have reliable transportation?
Yes No
Were you referred by a Flagstop employee?
Yes No
If YES, by whom?
SCHEDULE & PAY
Desired starting pay:
Per hour Per week
How many hours per week do you want to work?
During what times are you available to work?
Nights
Yes No
Weekends
Yes No
Overtime
Yes No
Holidays
Yes No
When can you start? (Date ex. 12/01/09)
Are you at least 16 years old?
Yes No
Are you at least 18 years old?
Yes No
SKILLS
Please list any special qualifications, training, education, skills, or experience that you feel warrant consideration.
Please list any business equipment, operating abilities you have which might be useful on the job for which you are applying.
EDUCATION
Highest elementary or high school grade completed.
Did you graduate from high school?
Yes
No
Obtained GED
Name of college, university or trade school(s):
Full-time Part-time
Field of study
Name of college, university or trade school(s):
Full-time
Part-time
Field of study
WORK EXPERIENCE #1
Name of present or last employer
Type of business
Street address
City
State
Dates of employment
Starting salary
Ending salary
Job title
Name of supervisor
Type of job
Full-time Part-time
Job description & responsibilities
Were you fired?
Yes No
Why did you leave?
If we contact this employer, would you expect them to say they would rehire you for the position you last held?
Yes No
If NO, please explain:
Employer's phone number
WORK EXPERIENCE #2
Name of employer prior to the job above
Type of business
Street Address
City
State
Dates of employment
Starting salary
Ending salary
Job title
Name of supervisor
Type of job
Full-time
Part-time
Job description & responsibilities
Were you fired?
Yes
No
Why did you leave?
If we contact this employer, would you expect them to say they would rehire you for the position you last held?
Yes
No
If NO, please explain:
Employer's phone number
WORK EXPERIENCE #3
Name of employer prior to the job above
Type of business
Street Address
City
State
Dates of employment
Starting salary
Ending salary
Job title
Name of supervisor
Type of job
Full-time Part-time
Job description & responsibilities
Were you fired?
Yes
No
Why did you leave?
If we contact this employer, would you expect them to say they would rehire you for the position you last held?
Yes
No
If NO, please explain:
Employer's phone number:
LEGAL
Have you ever been convicted of a crime other than a routine traffic violation?
Yes
No
If YES, enter date of conviction and explain:
NOTE: Conviction of a crime will not necessarily disqualify you from consideration for employment.
Enter Word Verification in box below *
* Required