List last three employers, starting with the most recent one first.

Please provide the names of three people not related to you, whom you have known for at least one year. By providing information on this form, you are consenting to allow us to contact these references on your behalf.

Reference #1

Reference #2

Reference #3 

I certify that all information on this application is correct. I authorize any agent or employee of D & R Intensive Car Care to verify this information and to release it to anyone who may consider me for appointment. I understand that intentionally providing false information on this form or attachments is a violation of state law. I also understand that applications submitted electronically, via e-mail or similar media, are not valid unless I enter my name in the signature field below and such action shall constitute an electronic signature.