Employment Application – Inland Propane

*Last Name

*First Name

Initial

Date

Current Address

City

State

ZIP

*Phone

*Email

Position applied for?

When are you available for employment?

Employment Desired

Full-time

Part-time

Temporary or Summer

Any

Desired Wage

Are you willing to work any shifts including nights, weekends or holidays?

Yes

No

Explain

Are you authorized to work in the United States?

Yes

No

(Proof of identity and eligibility will be required upon employment)

During the last ten years have you ever been convicted of a criminal offense?A conviction will not necessarily disqualify applicant

Yes

No

If yes, please explain (dates & location)

Are you over 18 years of age?

Yes

No

Are you over 21 years of age?

Yes

No

Have you ever worked/applied to work for Quick Stop stores or any businesses affiliated with or owned by Inland Oil & Propane Inc., Wenatchee BFS, BJ’s Food Marts, and Wenatchee Petroleum?

Yes

No

Explain

Who referred you to this company?

Do you know anyone who works for our company?

Yes

No

Explain

For Driving Jobs Only

Do you have a valid driver's license?

Yes

No

License Number and State Issued

CDL Classification?

Yes

No

EMPLOYMENT HISTORY

Include your last three (3) years of employment history, including periods of unemployment, list most recent first. Incomplete information could disqualify you from further consideration

01

Name of Current or Most Recent Employer

Address

Telephone

Type of Business

Dates Employed

FROM

TO

Rate of Pay

Starting

Ending

Reason for Leaving

Supervisor’s Name and Title

List the jobs you held, duties performed, skills used or learned, advancements or promotions

May we contact this employer for reference?

Yes

No

02

Name of Current or Most Recent Employer

Address

Telephone

Type of Business

Dates Employed

FROM

TO

Rate of Pay

Starting

Ending

Reason for Leaving

Supervisor’s Name and Title

List the jobs you held, duties performed, skills used or learned, advancements or promotions

May we contact this employer for reference?

Yes

No

03

Name of Current or Most Recent Employer

Address

Telephone

Type of Business

Dates Employed

FROM

TO

Rate of Pay

Starting

Ending

Reason for Leaving

Supervisor’s Name and Title

List the jobs you held, duties performed, skills used or learned, advancements or promotions

May we contact this employer for reference?

Yes

No

REFERENCES

Provide information for three persons not related to you who have known you at least one year and who can act as references for you

1. Name

Address

Business

Years Acquainted

2. Name

Address

Business

Years Acquainted

3. Name

Address

Business

Years Acquainted

4. Name

Address

Business

Years Acquainted

EMERGENCY CONTACT

Please list a name & phone number of person we contact in case of an emergency

*Name

*Phone Number

Certification

I certify that the answers given by me to the foregoing questions and during any interviews are true and correct without consequential omissions, and understand that, if employed, omissions and/or false statements on this application or during any interviews may result in dismissal. I understand and acknowledge that, if hired, my employment is for no definite period and either the Employer or I may terminate our relationship at will at any time, without notice or any reason, and that this employment application does not constitute an employment contract. I have had an opportunity to have my questions about this statement's content and intent answered and understand its terms.

I understand that any job offer that may be extended to me will be contingent upon the successful completion of a drug and alcohol test.

Background Check Approval

I have been advised that if employed I will be exposed to money, items of value, trade secrets, confidential business information, or proprietary business information. Thus, the company requires a criminal background check to determine whether I have been convicted of any crimes, including crimes against children. I authorize the company to conduct such background check on me and I further authorize it to contact and obtain information from such law-enforcement agencies as it deems appropriate, in any state or country. I understand and agree that the company will consider criminal convictions in determining whether such convictions are sufficiently related to the job for which I am applying such that my employment would not be in the best interest of the company. I further understand and agree that using a number of factors the company will evaluate whether any criminal conviction would jeopardize the safe or efficient operation of the business. I further understand that a conviction will not automatically disqualify me from employment with this company. I also understand that the company will notify me after it receives the record and that I have the opportunity to inspect it.

I have signed this application on the date indicated on the first page.

Signature

Date