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A Family & Employee Owned Maine Company Serving the People of Central Maine Since 1972

Employment Application

In compliance with Federal and State Equal Employment Opportunity Laws, all qualified candidates will be considered for employment without regard to their race, creed, color, national origin, ancestry, sex, age, marital status, veteran status, or the presence of non-job related medical conditions or disabilities.

Name of Applicant

Mailing Address

City & State

Zip

Residence Address

Home Phone

E-mail address

Are you currently employed?

Yes No

Day/Work Phone

May we contact you at work?

Yes No

May we contact your current employer?

Yes No

Date available to start

Position you are applying for

Preferred Location

Available to work
Check all that apply:

List any schedule preferences
needed and why:

Full Time

Part Time

Day Shift

Nights

Weekends

Temporary/Seasonal

Will you work overtime if asked?

Yes No

Can you travel if the job requires it?

Yes No

Are you 18 or older?

Yes No

If not, are you younger than 16?

If under 16, do you have a work permit?

Yes No

Have you or one of your immediate family members ever been employed by this company, in any division?

Yes No

If so, who, when & where?

Are you a legal citizen of the United States?

Yes No

If no, what legalizes your employment in this country?
*Proof of citizenship or immigration status will be required for employment

Would you willingly submit to pre-employment drug screening?

Yes No

Have you been convicted of a crime, including misdemeanors,
in the last 10 years? Do not include routine traffic violations.

Yes No

EDUCATION & TRAINING

Elementary School

High School

Business, Trade or Technical School

College

Graduate School

Have you ever had any job related training in the US Military?

Yes No

If yes, please describe

List professional, trade, business & civic activities and offices held.
You may exclude memberships which could reveal sex, race, religion, age,
national origin, ancestry or other protected status.

REFERENCES

List 3 references, neither related to you nor previous employers.
Give name, address & daytime telephone number.

EMPLOYMENT EXPERIENCE
Employer	Dates Employed		Work Performed
Address	From	To
Telephone Number
Job Title	Hourly Rate/Salary
Reasons for leaving	Starting	Final
May we contact this employer? Yes No
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Employer	Dates Employed		Work Performed
Address	From	To
Telephone Number
Job Title	Hourly Rate/Salary
Reasons for leaving	Starting	Final
May we contact this employer? Yes No
-----------------------------------------------------------------------------------------------
Employer	Dates Employed		Work Performed
Address	From	To
Telephone Number
Job Title	Hourly Rate/Salary
Reasons for leaving	Starting	Final
May we contact this employer? Yes No
-----------------------------------------------------------------------------------------------
Employer	Dates Employed		Work Performed
Address	From	To
Telephone Number
Job Title	Hourly Rate/Salary
Reasons for leaving	Starting	Final
May we contact this employer? Yes No
-----------------------------------------------------------------------------------------------
I consent to any and all medical examinations and drug screening required by J&S Oil, Inc.			Yes No
Are you involved with any clubs, professional organizations, community or school activities which you consider relevant to or which may restrict your ability to perform the job for which you have applied? If so, please list restrictions: Do not list organizations which reveal your sex, race, religion, age, or national origin.			Yes No

NOTICE: At time of interview, all applicants will be asked to verify the accuracy of all information provided and will be required to sign a printed copy of their application. If there are any changes you wish to make to this application, please do so before submitting it. Thank you.

Convenience Stores & Service Stations in These Maine Towns

Western Avenue MANCHESTER	Bay Street WINSLOW	Maine Avenue FARMINGDALE	Mt. Vernon Ave AUGUSTA	Lewiston Road TOPSHAM	Center Street AUBURN
Store Manager Rob Smith	Store Manager John Burns	Store Manager Ryan Carver	Store Manager Greg Davis	Store Manager Thelma Cusick	Store Manager Neal Morin
Directions to our store	Directions to our store	Directions to our store	Directions to our store	Directions to our store	Directions to our store
NOW OPEN, OUR NEWEST C-STORE ON KMD, IN WATERVILLE Store Manager Jason Goding Directions to our store

J&S Oil, Inc. Corporate Office ~ 867 Western Avenue, Manchester, Maine 04351
Phone: 1-207-622-1609 Fax: 1-207-622-7587