Job Application
Name:
*
First Name
Middle Initial
Last Name
Suffix
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Birth Date:
*
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Year
Phone #:
*
Format: (000) 000-0000.
E-mail Address:
*
Shirt Size:
*
Please Select
Small
Medium
Large
X-Large
2X Large
3X Large
Hoodie Size:
Please Select
Small
Medium
Large
X-Large
2XL
3XL
I was referred by:
Position Applying For:
*
Kitchen Staff
Janitorial Staff
Cashier
Overnight Cashier
Store Manager
Store 1
Store 2
Location applying for:
Corner Store Travel Center - Seminole, TX (Hobbs Hwy)
Corner Store Travel Center - Denver City
Corner Store 1 - Seminole, TX (Comanche)
Corner Store 2 - Seminole, TX (1788)
I am able to work (select ALL that apply):
*
Morning Shift (6 am - 2 pm)
Afternoon Shift (2 pm - 10 pm)
Overnight (10 pm - 6 am)
When can you start?
*
-
Month
-
Day
Year
The Travel Centers are both open 24/7 which includes ALL holidays. Are you able to work holidays as needed?
Yes
No
Back
Next
Employment History
List your current or most recent employment history
Are you currently employed?
Please Select
Yes
No
Employer name:
**If you have not been employed, please type 'N/A'
Employer listed above is:
previous employer
current employer
May we contact this employer?
Yes
No
If no, list reason we may not contact:
Business Phone #:
Supervisor/manager:
Position worked:
Job time:
Please Select
less than 1 year
1-2 years
2-3 years
3-4 years
5+ years
Pay:
Starting Pay
Most Recent Pay
Average hours worked weekly:
Reason for leaving:
Other Past Employers
Company:
Position:
Time worked there:
years and/or months
Hourly Rate:
Reason for Leaving:
Please list any other jobs or qualifications you have:
Education
Did you graduate High School?
*
Yes
No
If yes, what year did you graduate?
Reference
co-worker, past employer, boss etc.
Name:
*
First Name
Last Name
Phone Number:
*
Format: (000) 000-0000.
Relationship:
*
co-worker, past employer, boss etc.
Years Known:
*
We may contact the above listed reference:
*
Yes
No
Back
Next
1. Are you authorized to work in the United States?
*
Please Select
Yes
No
2. What can you provide for proof of eligibility of employment?
*
Please Select
ITIN #
Social Security #
3. Have you previously applied at Corner Store?
*
Please Select
Yes
No
3b. If yes, what date did you apply:
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
4. Do you have relatives who are currently employed with Corner Store?
*
Yes
No
4b. If yes, who is the relative?
5. Do you have reliable transportation to get you to and from work?
*
Please Select
Yes
No
6. Are you able and willing to travel for this job if travel is necessary?
*
Please Select
Yes
No
7. Are you aware of any reason that may restrict your ability to perform the essential functions of the job for which you are making application?
*
Please Select
Yes
No
7b. If yes, please explain and describe what accommodations might be necessary:
8. Have you ever been terminated or forced to resign from your employment with any employer?
*
Please Select
Yes
No
8b. If yes, provide Termination or Forced Resignation Reason:
9. During the past five years have you been convicted of , or have you pleaded guilty or no contest to, a felony offense?
*
Please Select
Yes
No
9b. If you answered yes on question 9, please explain:
10. If asked, are you willing to consent to a background check?
*
Yes
No
Back
Next
Emergency Contact
*
Name
Phone #
E-Mail
Relationship:
*
Please Select
Spouse
Partner
Parent
Relative
Friend
Other
When is the best time to contact you?
Morning (8 a.m. - 12 p.m.)
Afternoon (1 p.m. - 5 p.m.)
Disclaimer
I certify that I have fully and accurately answered all questions and have given all information requested in this application for employment, and I understand that any wrong or incomplete information on the form may disqualify me for further consideration for employment or, if discovered after I am hired, may be grounds for immediate dismissal. I understand that all such information is subject to verification by Corner Store, and hereby give my consent to Corner Store to investigate my background and qualifications using any means, sources, and outside investigators at its disposal. I agree to undergo any type of drug and/or alcohol testing that Corner Store may require at the time. Finally, I understand that submission of this application does not necessarily mean that I will be hired, and that if I am hired, my employment will be at will, and either I or Corner Store may terminate my employment at any; time, with or without notice or reason.
Signature
*
Submit Application
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