THIS FORM TO BE PRINTED AND FILLED OUT MANUALLY – NOT COMPLETED ON LINE

EMPLOYMENT APPLICATION FOR J&S OIL, INC.

Please complete & sign this three-page application and return it to the location to which you are applying.

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 Code
Residence Address, If Different:
Home Phone		E-mail address
Are you currently employed?		Day/Work Phone
May we contact you at work?		May we contact your current employer?
Date available to start		Position you are applying for
Preferred Location
Available to work (circle all that apply)
Full Time Part Time Day Shift Nights Weekends Temporary/Seasonal
List any schedule preferences
Will you work overtime if asked?		Can you travel if the job requires it?
Are you 18 or older?
If not, are you younger than 16?		If under 16, do you have a work permit?
Have you or one of your immediate family members ever been employed by this company, in any division?
If so, who, when & where?
Are you a legal citizen of the United States?		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?
Have you been convicted of a crime, including misdemeanors, in the last 10 years?
If so, please describe. Do not include routine traffic violations.
EDUCATION & TRAINING
High School			Years Completed
Trade or Technical School			Years Completed
College			Years Completed
Graduate School			Years Completed
Have you ever had any job related training in the US Military? 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, not related to you or previous employers.  Give name, address & daytime telephone number.
EMPLOYMENT EXPERIENCE
Most Recent Employer		Telephone Number
Address
Dates Employed		Job Title
Work Performed
Hourly Rate/Salary Start: ________ Final: ________		May we contact this employer?
Reasons for leaving
Previous Employer		Telephone Number
Address
Dates Employed		Job Title
Work Performed
Hourly Rate/Salary Start: ________ Final: ________		May we contact this employer?
Reasons for leaving
Previous Employer		Telephone Number
Address
Dates Employed		Job Title
Work Performed
Hourly Rate/Salary Start: ________ Final: ________		May we contact this employer?
Reasons for leaving
Previous Employer		Telephone Number
Address
Dates Employed		Job Title
Work Performed
Hourly Rate/Salary Start: ________ Final: ________		May we contact this employer?
Reasons for leaving
Do you consent to any and all medical examinations and drug screening required by J&S Oil, Inc.?
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.
Applicant’s Certification and Agreement – Please Read Carefully
I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I understand that, if employed, falsified statements or material omissions on this application shall be considered sufficient cause for dismissal. I hereby authorize you to make any investigation of my personal history record including the use of investigative agencies or bureaus of your choice.*
	*In accordance with the requirements of the Fair Credit Reporting Act, Title 15, U.S.C. S 1618 et seq., this is to disclose to you that we may request that an investigative consumer or credit report be prepared by a consumer of credit reporting agency as part of your application for employment with this Company. This report may include information as to your character, general reputation, financial condition, personal characteristics, and mode of living.
I also understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct, unless such a change is specifically acknowledged in writing by an authorized executive of this organization
NOTICE: At time of interview, all applicants will be asked to verify the accuracy of all information provided.
Signature of Applicant:				Date: