Employment Application: Non-Driver – Lubricant and Gasoline Distributor

Name

First

Last

Phone Number

Social Security #

Current Address

City

State/Province

Zip/Postal

Resume

Maximum upload size: 2.1MB

Please upload a PDF file.

Date available for employment?

Type of work desired:

If employed and under 18, can you furnish a work permit?

Yes

No

Have you ever been employed by this company?

Yes

No

Are you employed now?

Yes

No

Are you prevented from lawfully becoming employed in this country because of visa or immigration status?

Yes

No

If applying for a position where driving is required, do you have a valid driver's license in this state?

Yes

No

License #

Can you perform the essential functions of the job(s) for which you are applying?

Yes

No

Are you available to work:

Full-time

Part-time

Over-time

Have you ever been convicted of a felony?

Yes

No

Please note that a “Yes” answer will not bar you from consideration for employment.

If Yes, please explain.

Education

Elementary School

Years Completed

Secondary / High School

Years Completed

College

Course of Study

Years Completed

Graduate

Course of Study

Years Completed

Special Skills, Qualifications, and Considerations

Summarize special skills and qualifications, volunteer activities, military experience, employment or other activities related to the job you are seeking.

References

Name

Position/Relationship

Years Known

Phone

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Employment History

Employer

Supervisor's Name

Position Held

Address

City

State/Province

Zip/Postal

Phone Number

Start Date

End Date

Salary/Wage

Duties

What did you like most about your job?

Reason for Leaving

Add Remove

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE SIGNING THIS APPLICATION. IF YOU HAVE ANY QUESTIONS REGARDING THIS STAEMENT, PLEASE ASK THEM BEFORE SIGNING.

I certify that all answers and statements I have made on this application (and resume or other supplementary materials) are true and complete without omissions. By signing below, I authorize Hutchens Petroleum Corporation to investigate all statements contained in this employment application as they may deem necessary in arriving at an employment decision. I understand that any false information provided by me will likely result in a refusal to hire or immediate discharge if I am employed. I authorize any of the persons or organizations named in this application to give you complete information and records regarding my employment, education, character and qualifications.

If hired I will be responsible for familiarizing myself with all rules and regulations of HUTCHENS PETROLEUM CORPORATION as they presently exist or are later modified. If hired, I understand my employment can be terminated, at the discretion of HUTCHENS PETROLEUM CORPORATION or at my option, without notice, at any time and for any reason.

I also understand that no representative of HUTCHENS PETROLEUM CORPORATION has any authority to enter into any employment agreement for any specified period of time, or to assure me of any future position, benefits, or terms and conditions of employment, except as specifically stated in a current written agreement signed by the President.

I understand this application is not an offer of employment and no promises or representations of employment have made to me at this time.

I have read, understand, and agree with the above.

Signature

I certify that this application was completed by me, and all entries on it and information in it are true and complete to the best of my knowledge.