APPLICATION FOR EMPLOYMENT Please complete the company application in full. Resumes may be attached but NOT as a substitute. Only applications that are complete will be considered. APPLICANTS WILL BE TESTED FOR ILLEGAL DRUGS. All fields followed by * are required

PERSONAL INFORMATION

Last Name* First Name* Middle Name Maiden Name   Present Address Number* Street* City* State* Zip*   Home Phone* Cell Phone* Email Address*   Are you a United States Citizen or an Alien legally entitled to work in the U.S.?*YesNo   If you are hired can you submit proof of age?*YesNo   Have you ever been employed by a NAPA Auto Parts?*YesNo If Yes, give dates and position(s) held . . . Which store are you applying to?*BerthoudWindsorFort Lupton Are you bilingual?*YesNo If Yes, what languages?SpanishFrenchGerman Other   Answer only if the position you are applying for involves driving Licensed to drive a car?YesNo Is license valid in this state?YesNo Type (check)?D-1CDL-ACDL-B   Driver's license number*:   State of issue*:   Exp. Date*:     If hired do you have reliable transportation to work?*YesNo Have you ever been convicted of a DUI in any state?*YesNo Have you ever had your license suspended?*YesNo Have you had an accident in the past three years?*YesNo How many? Have you had a moving violation in the past three years?*YesNo How many? I am interested in:* StoreOfficeSalesDistribution CenterDelivery Truck DriverCDL Truck Driver Other:   I am seeking:* Temporary EmploymentRegular Employment If temporary indicate dates available:   I am available for:* Full-time EmploymentPart-time Employment If Part-time indicate maximum hours per week:   Are there any hours or days during the week when you would not be available to work?*YesNo If yes, please explain:   How soon are you available for work?*

U.S. MILITARY SERVICE

Branch of service   Date Entered   Date of Discharge   Highest Rank Held   Service related skills and experiences Applicable to civilian employment

EDUCATION

School Attended   No. of years   Name of school   City State   Gradute?   Course of study / Major   Average Grades   Sr. High         YesNo       Tech         YesNo       College         YesNo       Other         YesNo

EMPLOYMENT HISTORY

List below your four most recent employers, beginning with the current or most recent one. If you have had less than four employers, use the remaining spaces for personal references. If you were employed by more companies than space allows, pleas attach additional employer information using the attachment button below. If you were employed under a maiden or other name, please enter that name in the right hand box, if applicable.

NOTE: State reason for any length of inactivity between present application date and last employer:

REFERENCE #1

Name: Addr.:  City: State: Zip: Tel. No.   Start Date: End Date:   Supervisor:       Ending Pay (per week):       Detailed reason for leaving:

REFERENCE #2

Name: Addr.:  City: State: Zip: Tel. No.   Start Date: End Date:   Supervisor:       Ending Pay (per week):       Detailed reason for leaving:

REFERENCE #3

Name: Addr.:  City: State: Zip: Tel. No.   Start Date: End Date:   Supervisor:       Ending Pay (per week):       Detailed reason for leaving:

REFERENCE #4

Name: Addr.:  City: State: Zip: Tel. No.   Start Date: End Date:   Supervisor:       Ending Pay (per week):       Detailed reason for leaving:

By submitting this form, I certify that the information contained in this application is correct to the best of my knowledge and understand that any misstatement or omission of information is grounds for disqualification from any further consideration or for dismissal in accordance with Company policy. 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 release all parties from all liability for any damage that may result from furnishing same to you. In consideration of my employment, I agree to conform to the rules and regulations of the Company and my employment and compensations can be terminated with or without cause, and with or without notice, at any time, at the option of either the Company or myself. I understand that no manager or representative of the Company other than the President or Vice President of the Company has the authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing. In some states, the law requires that the Company have an applicant’s written permission before obtaining consumer reports or police records on an individual, and I hereby authorize the Company to obtain such reports. I further understand and agree to submit to a pre-employment SUBSTANCE ABUSE TEST

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