Application For Employment


Personal Information:

Name (First, MI, Last) *
Other Names you have been known by
Address *
City *
State *
Zip Code *
Phone Number *
Your Email *
Are you 18 years of age or older?
Yes   No  
Will you be able to show evidence that you are authorized to work in the United States?
Yes   No  
Have you been convicted of a felony in the last seven (7) years?
Yes   No  
If yes, please explain (answering yes will not necessarily disqualify any applicant from employment)

Position Information:

Position Desired
Full-time or Part-time?
Expected rate of pay
Date available to start *
Location
Reason for leaving?
Name of Supervisor
Have you ever been employed for Take 5 Oil Change before?
Yes   No  
Take 5 Oil Change has several locations and positions. Would you be willing to work permanently or temporarily at another location?
Yes   No  
If so, how far would you be willing to travel?
Desired Location(s)
Please check all that apply
Louisiana
New Orleans East Bank
3550 S I-10 Service Rd., Metairie, LA 70001
3100 W Esplanade Ave., Metairie, LA 70002
2124 Clearview Pkwy. Metairie, LA 70001
3600 Paris Rd., Chalmette, LA 70043
3905 Airline Dr. Metairie, LA 70001
2401 South Carrollton Ave., New Orleans, LA 70118
5280 Canal Blvd., New Orleans 70124
687 W. Campbell Rd, Richardson, TX
890 West Arapaho, Richardson, TX
5401 Alma, Plano, TX
3105 S. Jupiter, Garland, TX
3909 S. Broadway, Garland, Tx
Test Shop 1
Test Shop 2
2450 Severn ave Suite 308
Corporate Office
New Orleans West Bank
3803 Gen. DeGaulle Dr., Algiers, LA 70114
7104 Hwy 23, Belle Chasse, LA 70037
1700 Manhattan Blvd., Harvey, LA 70058
1895 Martin Luther King Jr Blvd Houma, La 70360
1628 Barataria Blvd Marrero, LA 70072
River Parish Region
13166 Hwy 90, Boutte, LA 70039
1413 W. Airline Hwy, Laplace, LA 70068
New Orleans Northshore
3849 Hwy 22, Mandeville, LA 70471
2167 Gause Blvd E., Slidell, LA 70461
4058 Hwy 59, Mandeville, LA 70448
104 West 30th Ave., Covington, LA 70433
198 Gause Blvd. West, Slidell, LA 70458
70443 Highway 21, Covington, LA 70433
Baton Rouge/Denham Springs/Hammond/Alexandria
8441 Airline Hwy. Baton Rouge, LA 70815
7808 Bluebonnet Blvd., Baton Rouge, LA 70810
10714 Coursey Blvd., Baton Rouge, LA 70816
414 Florida Ave., SW, Denham Springs, LA 70726
112 S. Morrison Blvd., Hammond, LA 70403
4820 Nelson Rd Lake Charles, La 70605
5615 Essen Ln Baton Rouge, La 70810
Lafayette
1500 W Pinhook Rd Lafayette, LA 70503
3120 ambassador Caffery Blvd, Lafayette, LA 70506
4006 Jackson St, Lafayette, LA 71301
705 E. Admiral Doyle Ave New Iberia, LA., 70560
Shreveport
8000 Youree Dr. Shreveport, La 71115
525 E kings Hwy Shreveport La 71105

North & South Carolina

1836 W. Mallard Creek Church Rd., Charlotte, NC 28262
1930 Sharonwood Ln Rock Hill, SC 29732
5110 Capital Blvd., Raleigh, NC 27616
1715 Battleground Ave, Greensboro, NC 27408
6301 Creedmoor Rd Raleigh, NC 27612
1795 E. Main St., Spartanburg, SC 29307
9200 Albemarle Rd, Charlotte, NC 28227
4030 Monroe Rd Charlotte, NC 28205
5221 South Blvd, Charlotte, NC 28217
117 State Park Rd. Greenville, SC 29609
1812 Savannah Hwy Charelston SC 29407
709 N Lake Dr, Lexington SC 29072
819 Folly Rd. - Charleston SC
4720 Devine St Clombia SC 29209
2920 North Center St, Hickory, NC 28601
110 W. Butler Rd. Maudin, South Carolina 29662
Mississippi

11310 Hwy 49, Gulfport, MS 39503
2698 Bienville Blvd. Ocean Springs, MS 39564
Alabama

1307 Government St., Mobile, AL 36604
3949 Airport Blvd Mobile, AL 36608
5540 Atlanta Hwy Montgomery AL 36117
27825 US 98 Daphne AL 36526
Virginia

1440 N Battlefield Blvd. Chesapeake, VA 23320
348 Newton Rd Virginia Beach, VA 23462
5337 Indian River Rd Virginia Beach, VA 23464
1928 Laskin Rd Virginia Beach, VA 23454
12543 Warwick Blvd Newport News, Va 23607
845 Lynnhaven Parkway Virginia Beach, VA 23452
5220 Brook Rd Richmond, Va 23227
Georgia

6569 Roswell Rd Atlanta, GA 30328
10870 State Bridge Rd Alpharetta, GA 30022
3075 Johnson Ferry Marietta, GA 30062
5 Whitlock Pl Marietta, Ga 30064
4698 Woodstock Rd Roswell, Ga 30075
4720 Atlanta Hwy 78 Loganville GA 30052
4290 Lawrenceville Hwy Lilburn Ga 30047
11585 Jones Bridge Rd Alpharetta, Ga 30022
1083 Scenic Hwy Snellville Ga 30078
Texas

2021 Richmond Ave Texarkana, TX 75501
3520 South Hwy 6 Houston, TX 77082
3311 Denton Hwy. Fort Worth, TX 76117
1412 S. Hwy 121, Lewisville, TX 75067
7706 Fry Rd Cypress, TX., 77433
401 N. Garland Ave Garland, TX 75040
Texas San Antonio

12520 Nacogdoches Rd. San Antonio, TX 78217
2800 Hillcrest Dr San Antonio, TX 78201
5012 Rigsby Ave. San Antonio, TX 78222
5723 Babcock Rd San Antonio, TX 78240
8511 Prue Rd San Antonio, TX 78249
11507 West Ave. San Antonio, TX 78213
3701 Colony Dr San Antonio, TX 78230
5996 De Zavala Rd San Antonio, TX 78249
1525 Austin Hwy San Antonio, TX 78218
1007 SE Military Rd San Antonio, TX 78214
254 N Loop 1604 E San Antonio, TX 78232
13603 San Pedro Ave San Antonio, TX 78232
9677 Marbach Rd San Antonio, TX 78245
7626 Culebra San Antonio, TX 78251
8318 Broadway St San Antonio, TX 78209
7545 FM 78 San Antonio, TX 78244
1227 Commercial Ave San Antonio, TX 78221
3018 Thousand Oaks Dr. San Antonio, TX 78247
4343 Vance Jackson San Antonio, TX 78230
14522 Blanco Rd. San Antonio, TX 78216
8803 Fredericksburg Rd. San Antonio, TX 78240
992 S Business IH 35 New Braunfels, TX 78130
800 Pat Booker Rd San Antonio, TX 78148
11505 Toepperwein Rd Live Oak, TX 78233
9280 FM 78 Converse, TX 78109
1061 S Walnut Ave New Braunfels, TX 78130
1620 FM 2673 Canyon Lake, TX 78133
3901 FM 3009 Schertz, TX 78154
1102 S Main St. Boerne, TX 78006
12266 Bandera Rd Helotes, TX 78023
17080 TX-46 Spring Branch, TX 78070
Texas Austin

15207 FM 1825 Pflugerville, TX 78660
1000 Hwy 80 San Marcos TX 78666
3609 S. 31st St. Temple TX 76502
1200 Thorpe Ln. San Marcos, TX 78666
13781 Research Blvd Austin TX 78750
2312 W. Parmer Ln Austin Texas 78727
5400 Balcones Dr. Austin TX 78731
1003 Bacon Ranch Rd Killeen, Tx 76542
Texas DFW

7817 Forest Ln Dallas, TX 75230
4555 Forest Ln Garland, TX 75042
9080 Forest Ln Dallas, TX 75243
5720 E. Mockingbird Dallas, TX 75206
17638 Preston Rd Dallas, TX 75252
4004 Lemmon Ln Dallas, TX 75219
3540 Forest Ln Dallax, TX 75234
601 W. Centerville Rd Garland, TX 75041
6403 Greenville Ave Dallas, TX 75206
9707 Plano Rd Dallas, TX 75238
2625 Midway Rd Carrollton, TX 75006
2214 N. Town East Blvd Mesquite, TX 75150
6190 Belt Line Rd Dallas, TX 75254
1198 N. Plano Rd Richardson, TX 75081
1732 E. 14th St Plano, TX 75074
3067 W. 15th St Plano, TX 75074
570 W. Weatleand Rd Duncanville, TX 75116
651 Alta Mere Dr Fort Worth, TX 76114
Texas Houston

1818 N. Shepherd Dr. Houston, Tx 77008
7120 Louetta Rd Spring, TX 77379
1837 Richmond Ave Houston TX, 77098
2413 W Holcombe Blvd Houston TX 77030
4450 Woodlands Pkwy Woodland, TX 73181
7940 Research Forest Dr Springs, TX 77382
2020 Loop Hwy 336 West, Conroe, TX 77304
1565 11th St., Huntsville, TX 77340
111 Southwest Pkwy College Station TX 77840
1621 Briarcrest Dr Bryan, TX 77802
14519 Bellairie Blvd. Houston, TX 77083
442 Rayford Road Spring, TX., 77386
2731 Hillcroft St Houston, TX., 77057
3930 Fairmont Pkwy Pasadena, TX 77504
114 W Baker Rd Baytown, TX 77521
806 Southmore Ave, Pasadena TX 77502
6435 Fairmont Pkwy, Pasadena TX 77505
8434 Spring Cypress Rd Spring, Tx 77379
9560 Hwy 6 Missouri City TX 77459
1405 FM 1092 Missouri city TX 77459
505 Durham Dr Houston TX 77007
10177 TX 242 Conroe TX 77385
10802 Westheimer Rd Houston, TX 77042
3147 W Broadway St Pearland TX 77581
7934 Westview dr Houston TX 77055
Florida

6891 N 9th Ave Pensacola, FL 32504
4890 Park Boulevard, Pinellas Park, FL 33781
714 Cassat Ave Jacksonville, Fl 32205
340 W Granada Blvd Ormond Beach, Fl 32176
115 S Nova Road Daytona Beach, Fl 32114
200 North Dixie Frwy New Smyrna Beach, Fl 32168
1440 W Granada Blvd Ormond Beach, Fl 23320
3680 E Silver Springs Blvd Ocala, Fl 34470
1708 E Silver Springs Blvd Ocala Florida
2425 SE 58th Ave Ocala, Fl 34471
16730 SE US Highway 441 Summerfield, Fl 34491
5330 SE Abshier Blvd Belleview, Fl 34420
1634 Taylor Rd Port Orange, Fl 32124
101 Victorian St Kingsland, GA., 31548
1690 South 8th St Fernandina Beach, Fl 32034
1060 Palm Coast Pkwy NW Palm Coast, Fl 32137
4020 Southside Blvd Jacksonville, Fl
8539 Beach Blvd Jacksonville, Fl 32216
804 Blanding Blvd Orange Park, Fl 32065
1204 N University Blvd Jacksonville, Fl 32211
6804 103rd St Jacksonville, Fl 32210
8165 103rd St Jacksonville, Fl 32210
1030 N Edgewood Ave Jacksonville, Fl 32254
8402 N Armenia Ave Tampa, Fl
4846 4th St North St. Petersburg, Fl 33703
6903 66th St North Pinellas Park, Fl 33781
2070 Gulf to Bay Blvd Clearwater, Fl 33765
5202 Cortez Rd West Bradenton, Fl 34210
5309 Gunn Hwy Tampa, Fl 33624
319 South Spring Garden Ave Deland, Fl 32720
2502 West Kennedy Blvd Tampa, Fl 33609
6606 14th St West Bradenton, Fl 34207
12518 San Jose Blvd Jacksonville, Fl 32223
11150 San Jose Blvd Jacksonville Fl 32223
2985 East Bay Dr Largo, Fl 32257
8924 San Jose Blvd Jacksonville, Fl 32257
1555 Dunn Ave Jacksonville, Fl 32218
5930 University Blvd West Jacksonville, Fl
6225 SW Hwy 200 Ocala, Fl 34476
102 North Hwy 27 Lady Lake, Fl 32159
1950 Lee Rd Orlando, Fl 32810
200 N. State Rd 434 Altamonte Springs, Fl 32714
6334 University Blvd Winter Park, Fl 32792
105 W. Brandon Hwy (60) Brandon, FL 33511
4319 Ehrlich Rd Tampa, Fl 33624
8201 W. Hillsborough Ave Tampa, Fl 33615
1502 Charles Ave Plant City, Fl 33563
5126 US Hwy. 98 North Lakeland, Fl 33809
13376 Lincoln Rd Riverview, Fl 33578
5122 E Fowler Ave Tampa, Fl 33617
3767 Orlando Dr Sanford, Fl 32773
6059 S Florida Ave Lakeland, Fl 33813
13480 Beach Blvd Jacksonville, Fl 32224
121 N 14th St Leesburg, Fl 34748
12304 W Colonial Dr Winter Garden, Fl 34787
830 E Brandon Blvd Brandon Florida
215 E. Main St Apopka, FL 32703
2468 Citrus Blvd Leesburg Florida
2671 Roosevelt Blvd. Clearwater, FL 33760
1240 Missouri Avenue Largo, Fl., 33771
1025 N Navy Blvd Pensacola Fl 32507
3501 S Dale Mabry Tampa, FL. 36029
11211 N Dale Mabry Carrollwood, Fl 33624
1213 SEC John Sims Pkwy Niceville Fl 32578
1698 34th St N St Petersburg Fl 33713
3501 S Dale Mabry Tampa, FL. 36029
Ohio

1100 Evans Way Ct Columbus OH 43228
2780 Morse Rd Columbus OH 43231
4844 N. High St Columbus, OH 43214
1233 W 5th Ave Columbus OH 43212
2385 Schrock Hill Ct Columbus OH 43229
6066 Sawmill Rd Dublin OH 43017
76 Reynoldsburg-New Albany Rd Blacklick OH 43004
6668 Mayfield Rd Mayfield Heights, OH 44124
5191 Turney Rd. Garfield Heights, OH 44125
33300 Aurora Rd Solon, OH 44139
511 Avon Belden Rd Avon Lake OH 44012
5235 Northfield Rd. Bedford Heights OH 44146
4310 W. 150th, Cleveland, OH 44135
2100 Lee Rd. Cleveland Heights OH 44118
33707 Vine St. Willowick OH 44095
20501 Euclid Ave Euclid OH 44117
1476 W. 117th St. Lakewood OH 44107
16910 Detroit Ave Lakewood OH 44107
6119 Mayfield Rd. Mayfield Heights OH 44124
4215 Pearl Rd Medina OH 44256
7569 Mentor Ave Mentor OH 44060
8725 Mentor Ave Mentor OH 44060
17780 Bagley Rd Cleveland OH 44130
28401 Lorain Rd. North Olmsted OH 44070
1572 Mentor Ave Painesville OH 44077
7507 Brookpark Rd Parma OH 44129
5668 Broadview Rd Parma OH 44134
4021 Mayfield Rd South Euclid OH 44121
16808 Royalton Rd Strongsville OH 44136
8890 Darrow Rd Twinsburg OH 44087
1220 Columbia Rd Westlake OH 44145
34545 Euclid Ave. Willoughby OH 44094
7805 Broadview Rd Seven Hills OH 44131
21459 Center Ridge Rd Fairview Park OH 44116
591 Canton Rd Akron OH 44312
980 East Waterloo Rd Akron OH, 44306
1980 West Market St Akron, OH 44313
876 Wooster Rd North Barberton, OH 44203
3106 Whipple Ave Canton, OH 44718
1948 State Rd Cuyahoga Falls, OH 44223
3908 Medina Rd Akron, OH 44333
4424 Kent Rd Stow, OH 44224
1037 High St Wadsworth, OH 44281
1413 E. 4000N Rd. Bourbonnais IL 60914
1680 W. Court St. Kankakee IL 60901
1609 N. Bloomington St. Streator IL 61364
4610 Avenue of the Cities Moline IL 61265
901 41st Ave Dr Moline IL 61265
3947 41st Ave. Moline IL 61265
5303 Jersey Ridge Rd. Davenport IA 52807
3901 W. Baring Trace Peoria IL 61615
3311 N. Sterling Ave. Peoria IL 61615
2505 E. Washington St. East Peoria IL 61611
3322 Court St. Pekin IL 61554
1889 Washington Rd. Washington IL 61571
1277 N. Henderson St. Galesburg IL 61401
1227 N. Main St. Princeton IL 61356
4239 Venture Dr. Peru IL 61354
140 N. Springboro Pike, Miamisburg OH 45449
2755 Alex Bell Rd W Moraine, OH 45459
7505 S. Liberty Rd Liberty Twp., OH 45044
1190 E. Kemper Rd, Cincinnati OH 45246
Oklahoma

2400 W. Main St. Norman, OK 73069
4502 S Sheridan Rd Tulsa, OK 74175
8108 S Harvard Ave Tulsa OK 74137
7122 S Memorial Tulsa OK 74133
17 N Council Oklahoma City OK 73127
9340 N May Avenue Oklahoma City OK 73116
4100 N may Oklahoma City OK 73112
3024 S Broadway, Edmond OK 73013
170 12th Ave SE Norman, OK 73071
508 East Kenosha Street Broken Arrow, OK 74014
12021 S Western Oklahoma City OK 12021
580 E. Kenosha St, Broken Arrow OK 74012
4826 S. Sooner Rd Oklahoma City, OK 73121
Tennessee

6200 Charlotte Pike Nashville, TN 37209
6525 Poplar Ave. Memphis Tn 38119
 
 
Schedule Availability:

Specify hours available each day of the week, please keep in mind that the availability of hours/time/day may vary.

Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Education:

Highest level of education attained?(For example, High School, College, Vocational) Years Completed? (If you graduated, please provide date of graduation.)
Date:
Employment History: (For the past 10 years)

Company
Address
Phone
Pay Rate
Employment Dates (From-To)
Reason for Leaving
Company
Address
Phone
Pay Rate
Employment Dates (From-To)
Reason for Leaving
Company
Address
Phone
Pay Rate
Employment Dates (From-To)
Reason for Leaving
References

List two people (not relatives)of professional references that you have worked with who we may contact


Name Address Phone Number Occupation

I understand that nothing in this application, or in any prior or subsequent written or oral statement, creates a contract of employment or any rights in the nature of a contract. I agree and understand that if I am hired by Take 5 Oil Change LLC, my employment will be at-will, for an indefinite period of time, and may be terminated at any time, with or without cause or notice, at the option of Take 5 Oil Change LLC or myself. I also understand that no one has the authority to enter into any contract, agreement or modification of the foregoing unless such contract, agreement or modification is in writing and signed by the president of Take 5 Oil Change LLC.

Signature (Please type your full name):
Date:

Thank you for taking the time to fill out this application for employment. Please note that your application will remain active for 90 days following its execution. Any applicant interested in employment beyond this period of time must complete a new application with Take 5 Oil Change.