Retail Application

First Name *

Middle Name *

Last Name *

Email *

Address

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Phone *

Phone 2

Driver's License Number *

Driver's License State *

Driver's License Expiration Date *

How many addresses have you had in the last 5 years? *

Are you a US Citizen *

YesNo

If not, do you have the legal right to work in the US (Visa)? *

YesNoN/A

Are you at least 21 years old? *

YesNo

What kind of employment are you currently seeking? *

Part timeFull timeTemporary

What position are you applying for? *

Salary Desired *

Least Acceptable Salary *

What hours and shift(s) would you prefer to work?

Any hours/shiftMorningAfternoonNight

Define hours or shift desired and/or indicate any hours/shifts you will not be able to work, if any

Are you willing to work the following?

OvertimeWeekendsHolidays

Have you ever worked for Beach Oil Co. before?

YesNo

If yes, please indicate name used

Name any friends or relatives currently working for the company, if any

Are you currently employed? *

YesNo

Date available to start *

Are you on layoff and subject to recall? *

YesNo

Have you ever been discharged or asked to resign from any position? *

YesNo

If yes, please describe

How many days of work/school have you missed within the last 12 months? *

How many days have you been late reporting to work/school within the last 12 months? *

How many days have you missed from work/school for other reasons within the last 3 years? *

Additional info about missed days

Bonding and money handling policies require that we ask if you have ever been convicted of a felony? *

YesNo

Are you on parole? *

YesNo

Are you awaiting trial? *

YesNo

If yes, state the nature of the offense and disposition of the case. Include dates and places.

Emergency Contact Name *

Emergency Contact Phone *

Emergency Contact Address

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Please complete the following information starting with your most recent or current employment. At least one employment reference is required.

Employer 1 *

Position *

Phone *

Address *

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Supervisor *

Duties *

Start Date *

End Date *

Reason for leaving *

Employer 2

Position

Phone

Address

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Supervisor

Duties

Start Date

End Date

Reason for leaving

Employer 3

Position

Phone

Address

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Supervisor

Duties

Start Date

End Date

Reason for leaving

List any special skills, experience, or training.

Hobbies or special interests

How did you find out about this job?

By submitting this application online in consideration for employment with Beach Oil Co. (from now on referred to as "the Company" you acknowledge that you have read and understand the following statements: 1. You grant permission to the Company to investigate my previous employment, educational background, past criminal records (if any) and character references. You release all persons who furnish such information to the Company from all liabilities and damage and that upon your request, the Company shall make a complete and accurate disclosure of the nature and scope of such investigation if one is made. 2. You agree to conform to the rules and regulations of the Company set forth in the employee handbook and acknowledge that these rules may be changed, interpreted, withdrawn, or added to by the Company at any time, at the employer's sole option and without any prior notice to me. 3. You acknowledge that if you are employed by the Company your employment will be at will, and might be terminated with or without cause at any time by me or by the Company. 4. You understand that no representative of the Company has any authority to enter into any agreement for employment for any specified period of time or to assure any benefits or terms and conditions of employment prior to commencement of employment or after you have become employed. 5. Upon or during your employment, and when deemed appropriate by the Company, you agree to cooperate fully in any or all investigations involving suspect or possible violations of Federal, State or County laws, or Company policy. 6. You acknowledge that your application will be reviewed and considered given current Company's needs but its receipt by the Company does not imply that you will be further contacted, offered employment, or be employed by the Company. 7. You declare that the information provided by you on this application is true and complete and that you have not failed to disclose any information that could be considered relevant to the Company's hiring decision. You further understand that any falsification or misleading information are grounds for refusal to hire, dismissal, and forfeiture of related benefits. E-Sign: By typing your name in the box below you acknowledge the information, details, and policies explained to you in this application and agree to have read and understand them.

Applicant's Signature *

Date Signed

EMPLOYMENT HISTORY

CONSENT TO DISCLOSURE - PLEASE READ AND SIGN BELOW

Verification