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EMPLOYMENT APPLICATION

(PHONE) 714.530.4795 (FAX) 714.530.5026 (E-MAIL) info@cafueling.com

Are you legally authorized to work in the United States? Proof of legal authority to work in the United States will be required upon employment. *

Available Start

Are you at least 18 years of age? *

Referred By: (Please check applicable box and specify if other source)

EMPLOYMENT HISTORY

Start with most recent or present employer.

Please Include part time and self-employment and explain periods of non-employment below.

May we contact this employer? *

May we contact this employer?

May we contact this employer?

EMPLOYMENT APPLICATION

(PHONE) 714.530.4795 (FAX) 714.530.5026 (E-MAIL) info@cafueling.com

If you are applying for a position where driving is a requirement of the job, please answer the following questions:

Do you have the full use of an automobile? *

Do you have a valid driver's license? *

License # Issuing State Exp. Date

Within the past three years: How many moving violations have you had? How many traffic accidents have you had?

Have you previously been employed by California Fuels and Lubricants? *

If yes:

Position(s) held Under what name? From To Reason for Leaving

Are you subject to any employment agreement that could impact your ability to work for CFL? *

If yes, please attach copy of the agreement(s)

EMPLOYMENT APPLICATION

(PHONE) 714.530.4795 (FAX) 714.530.5026 (E-MAIL) info@cafueling.com

All persons shall have equal employment opportunities with California Fuels and Lubricants regardless of race, color, creed, religion, national origin, ancestry, sex, marital status, sexual orientation, disability, age and any other legally protected class and within the framework of federal law regarding age discrimination, employment of the handicapped and Vietnam era veterans. Employment shall be based solely on the company's need and the individual's qualifications

l certify that I have completed this application and the statements I have made in this application are true and complete. I authorize investigation of all statements contained in this application which California Fuels and Lubricants may deem relevant to my employment and authorize my previous employers or other persons having information concerning my records or me to report such information to California Fuels and Lubricants. I hereby release California Fuels and Lubricants, my former employer or other persons who may provide information from any liability as a result of providing such information.

l understand and agree that if it is subsequently discovered that the information is untrue or that I have failed to disclose a material fact, any offer of employment made to me by California Fuels and Lubricants may be immediately withdrawn or if I am already employed by California Fuels and Lubricants, I may be subject to immediate dismissal at California Fuels and Lubricants' option. In such event, the withdrawal of any offer of employment made to me or the termination of employment shall be without any obligation or liability to me by California Fuels and Lubricants, other than for wages at the rate agreed upon for work I have actually performed for California Fuels and Lubricants

If I become employed, in consideration of my employment, I understand that I must comply with the rules, regulations, policies and procedures of the company. I am aware of and understand the physical requirements of the job and certify that I can and will perform these requirements in a safe manner, with or without accommodation.

ln accordance with the Immigration and Control Act of 1986 California Fuels and Lubricants will only hire United States citizens and aliens lawfully authorized to work in the United States. I understand that I will be required to complete the designated employment eligibility verification I-9 Form as a condition of employment.

l understand that I may be required to undergo drug testing and/or a background check and that my employment is contingent upon these results. I will be advised if this is required and complete the necessary authorizations. I understand that I am not obligated to disclose sealed or expunged records of conviction or arrest, nor may California Fuels and Lubricants ask me if I have had records sealed or expunged.

l understand and agree that if I am employed as a result of this application, my employment will be at at-will, which I understand means that I will not be employed for any definite period of time and that my employment may be terminated at any time. At-will employment may only be modified by written agreement signed by an officer of the company.

Signature: Print Name: Date: