Job Application for Corner Store Travel Center

Job Application for Corner Store Travel Center
Name: *

First Name Middle Initial Last Name Suffix
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Birth Date: *

Month Day Year
Mobile Phone *
E-mail Address: *
Shirt Size: *
Position Applying For: *

Custodian Kitchen Staff Cashier Floater (does all three positions)
I am able to work (select ALL that apply): *

Morning Shift (6 a.m. - 2 p.m.) Afternoon/Evening Shift (2 p.m. - 10 p.m.) Weekends (Saturdays & Sundays)
We are open 24/7 which includes ALL holidays. Are you able to work holidays as needed? *

Yes No
When can you start? *

Month Day Year

Employment History

List your current or most recent employment history
Are you currently employed? *
May we contact your current employer?

Yes No
If no, list reason we may not contact current employer:
Current Employer:
**IF YOU ARE NOT CURRENTLY EMPLOYED PLEASE TYPE IN 'NOT EMPLOYED'
What is your position?
Last Position You Held
Who is your supervisor/manager?
Immediate Supervisor(s)
Business Phone Number:
Phone Number(s)
Job Time & Pay:

Dates of Employment Most Recent Salary or Hourly Rate
Hours Worked & Reason for Leaving:

Hours worked per Week Reason for Leaving
May we Contact this Employer?
If you selected no, please explain:
Other Past Employers
Company:
Position:
Time worked there:
years and/or months
Hourly Rate:
Reason for Leaving:
Please list any other jobs or qualifications you have:
Education
Did you finish High School? *

Yes I graduated No I didn't
If yes, what year did you graduate?
Reference

family member, co-worker, past employer, etc.
Name: *

First Name Last Name
Phone Number: *
Relationship: *
family member, co-worker, past employer, friend, etc.
Years Known: *

1. Can you provide proof of eligibility to become employed in the United States? *
2. What can you provide for proof of eligibility of employment? *
3. Have you ever filled out a job application with Corner Store before? *
3b. If yes, what date did you apply:

Month Day Year
4. Do you have relatives who currently are employed with Corner Store? *

Yes No
4b. If yes, who is the relative?
5. Do you have adequate transportation to meet travel requirements of the job? *
6. Are you able and willing to travel for this job if travel is necessary? *
7. Are you aware of any reason that may restrict your ability to perform the essential functions of the job for which you are making application? *
7b. If yes, please explain and describe what accommodations might be necessary:
8. Have you ever been terminated or forced to resign from your employment with any employer? *
8b. If yes, provide Termination or Forced Resignation Reason:
9. Have you ever been convicted of a crime including any driving and/or alcohol related offenses? *
9b. If you answered yes on question 9, please explain:

Emergency Contact *

Name Phone E-Mail
When is the best time to contact you?

Morning (8 a.m. - 12 p.m.) Afternoon (1 p.m. - 5 p.m.)
Should be Empty:

Employment History