T & M Enterprises: Online Application If you are a human and are seeing this field, please leave it blank. Fields marked with a * are required First Name * Middle Initial Last Name * Address * Apt No. City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * Phone * Email * Are you 18 or older? * YesNo If no, Age Have you ever worked for Jiffy Lube before? * YesNo If yes, dates and location What is Your Availability Total Hours Available per week Hours Available Monday Start Time End Time Tuesday Start Time End Time Wednesday Start Time End Time Thursday Start Time End Time Friday Start Time End Time Saturday Start Time End Time Sunday Start Time End Time Are you able to work in the U.S.? * YesNo Do you have transportation to work? * YesNo * Allentown – 1050 S. 4th StreetExeter - 4760 Perkiomen AvenueHarrisburg - 4007 Jonestown RoadHummelstown - 1900 Kaylor RoadKing of Prussia - 590 W. Dekalb PikeNorristown - 12 West Germantown Pk. Paoli - 73 East Lancaster Avenue Scranton - 208 Meadow AveScranton - 739 Oak StreetSinking Spring - 20 Shillington RoadTaylor – 1500 S. Main AvenueWilliamsport - 1829 East Third StreetWillow Street - 2607 Willow Street Pike York - 3308 East Market StreetYork - 705 Loucks RoadCollegeville - 809 Gravel Pike How did you hear of this position? Position Desired (based on qualifications) Lube TechSupervisorManager School Most Recently Attended School Name Location Phone Teacher or Counselor Grade completed GPA Graduated YesNo Now enrolled? YesNo Sports/Activities Recent Job Company Location Phone Job Title Supervisor Name Dates Worked Start Date End Date Reason for leaving APPLICANT'S STATEMENT AND AGREEMENT In addition to this online application, you must complete a full application form prior to any final employment decision. You agree that if hired, your employment will be subject to all employment policies, terms and conditions of employment in effect at this Jiffy Lube. Ask the store manager for details. I fully understand and agree that all statements made herein are subject to investigation and confirmation by Jiffy Lube and that, if any such statement made by me is either a misrepresentation or false or misleading in any way, or if I have omitted any fact which makes this application false or misleading, such conduct shall constitute just and sufficient cause for refusal of employment or immediate discharge from employment at any time after discovery is made by Jiffy Lube. I further understand that the forgoing conditions apply to information included or omitted from any resume which I have submitted. I acknowledge that my electronic signature on this application serves as my consent to the conduct of, and my promise to cooperate fully in, any investigation which may be conducted by the Company. I understand that my refusal to cooperate with any such investigation shall constitute good and sufficient cause for the termination of my employment or withdrawal of this application from further consideration. I hereby agree that should I be employed by Jiffy Lube, either in the position applied for or in some other position nor or hereafter, such employment may be terminated by Jiffy Lube at any time, without liability to me for wages or salary, except such as may have been earned at the time of such termination. Prior to any offer of employment, I agree to provide Jiffy Lube documents as prescribed by the Immigration Reform and Control Act of 1986, which verifies my eligibility to be employed in the U.S. I FULLY UNDERSTAND AND AGREE TO COMPLY WITH ALL CONDITIONS STATED ABOVE. Name Date