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TIRE & AUTOMOTIVE CENTERS
LAMB VENTURES, INC.
Employment Application
Personal Information
Date: 1/5/2009 Social Security Number:
 E-mail Address:
Last Name:
 First Name:
 Middle Name:
PRESENT ADDRESS:

 CITY:
 STATE:

 ZIP:
 TELEPHONE NUMBER:
PERMANENT ADDRESS:

 CITY:
 STATE:

 ZIP:
 TELEPHONE NUMBER:

ARE YOU PRESENTLY LEGALLY AUTHORIZED TO WORK IN THE UNITES STATES ON A FULL-TIME BASIS?

1ST LOCATION PREFERENCE:
 2ND LOCATION PREFERENCE:
 THE AGE DISCRIMINATION IN EMPLOYMENT ACT OF 1967, AS AMENDED, PROTECTS APPLICANTS AND EMPLOYEES 40 YEARS OF AGE OR OLDER FROM DISCRIMINATION ON THE BASIS OF AGE IN HIRING PROMOTION, DISCHARGE, COMPENSATION, TERMS, CONDITIONS OR PRIVILEGES OF EMPLOYMENT.
YES    NO
ARE YOU UNDER 18?
YES    NO
Do you have a valid drivers license?
 Has it ever been suspended or revoked?
 Have you ever been convicted for other than a minor traffic violation? if so, give date, nature and place of each conviction:
YES    NO
YES    NO
YES    NO
current License #
have you ever been bonded?
YES
NO
 if Yes, what company?
State:
 have you ever been refused a bond?
YES
NO
if so, what company and reason?
Education
Name of School or College:
 Location:
Attended (1)
Major Subject :
Scholastic Average:
Did you graduate?
From
to
High School:
month
year
 month
 year
YES
NO
Trade, Business or Correspondence School?:
YES
NO
College:
YES
NO
Employment(List the last four employers, starting with the most recent one)
Employer:

 Address:

 Position/Title:
Describe Work Experience:
Dates Employed (Mo/Year):
From: To: 		Salary:
 Supervisor:
 Reason for Leaving:
Employer:

 Address:

 Position/Title:
Describe Work Experience:
Dates Employed (Mo/Year):
From: To: 		Salary:
 Supervisor:
 Reason for Leaving:
Employer:

 Address:

 Position/Title:
Describe Work Experience:
Dates Employed (Mo/Year):
From: To: 		Salary:
 Supervisor:
 Reason for Leaving:
Employer:

 Address:

 Position/Title:
Describe Work Experience:
Dates Employed (Mo/Year):
From: To: 		Salary:
 Supervisor:
 Reason for Leaving:
Have you ever worked at a Lamb's location before?
YES    NO
If "YES", please state where and dates of service.
Why do you wish to leave your present employer?
May we refer to your present employer?
YES    NO
For what position are you applying?
Minimum Base Salary:
 If offered employment, how soon can you report to work?
Describe briefly the type of work which your are best qualified to do by reasom of education, previous employment, or training and tell why you feel qualified for the position for which you are applying.
Personal References (Other than former employers and relatives)
Name:
 Address:
 Occupation:
Name:
 Address:
 Occupation:

EQUAL EMPLOYMENT OPPORTUNITY POLICY

It is the policy of Lamb’s Tire & automotive Centers that applicants for employment are recruited, selected and hired on the basis of individual merit and ability with respect to positions being filled and potential for promotions or transfer which may be expected to develop. Applicants are to be recruited, selected and hired without discrimination because of race, color, religion, sex, age, national origin, handicap or disability.

In addition, personnel procedures and practices with regard to training, promotion, transfer, compensation, demotion, lay off or termination, are to be administered with due regard to job performance, experience and qualifications, but without discrimination because of race, color, religion, sex, age, national origin, handicap or disability.

The company is subject to Section 503 of the Rehabilitation Act of 1973 and Section 402 of the Vietnam Era Veterans Readjustment Assistance Act of 1974 which require that the company take affirmative action to employ and advance in employment qualified handicapped individuals and disabled veterans. If you have such a handicap or disability and would like to be considered under these affirmative action programs, please inform the employment office.

Information obtained concerning individuals shall be kept confidential, except when necessary for managerial decisions.

I certify that all the information contained in this application is true, complete and correct to the best of my knowledge, and I understand that any material omission, misrepresentation or falsification of this information is grounds for dismissal from or refusal of employment, I hereby authorize investigation of all statements contained in this application.

I also hereby authorize Lamb’s to prepare or cause to be prepared an investigative consumer report (which may include information as to my character, general reputation, personal characteristics, and mode of living) which will or may be based upon personal interviews with my neighbors, friends and associates. Upon my written request, the complete nature and scope of the investigation will be disclosed. If employment is denied wholly or partly because of an adverse investigative consumer report, I understand that I will be advised of this fact including the name and business address of the reporting company.

I authorize the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and I release all parties from all liability for any damage that may result from furnishing my information to you.

It is my understanding that if hired, my continued employment would be contingent upon my adhering to the rules, regulations, policies and procedures in effect, and failure to do so can result in my termination without notice.

I may terminate my employment with Lamb’s Tire & Automotive Centers at any time, for any reason; and Lamb’s Tire & Automotive Centers for any reason, may terminate me, my compensation, and vested benefits at any time. No employee of Lamb’s Tire & Automotive Centers may change the terms of this agreement.

I agree with the above statement

This application will be effective for 60 days from the date above. After 60 days, applicants must refile for further consideration.