EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION
FULL TIME EMPLOYMENT
PART TIME EMPLOYMENT
Name (Last)
(First)
Date of application

MonthDayYear
Date
(Middle)
Home Address
Home Telephone
Date of Birth

MonthDayYear
Date
Position Applying For
Date Available

MonthDayYear
Date
Salary Expected
Technical Specialization
Are you related to anyone now employed with The Pumping Station, Inc.?

Have you ever been convicted for a criminal offense?
Please Explain
Yes List employment starting with your most recent position. May we contact your present and/or past employer(s)? DateSalary or WagesList Major DutiesReason for Leaving
5.)
Have you previously worked for a convenience store company?
Name
Location
City & State
Position Held
Supervisor
Reason for leaving
Business references: (do not list relatives) (please indicate if you were employed under a different name)
Title
In submitting this application for employment. I understand that an investigation mayl be made whereby information is obtained regarding my character, previous employment, general reputation, educational background, credit record, and/or criminal history. I authorize anyone possessing information to furnish it to TPS, Inc.and/or a 3rd party company upon request and I release anyone so authorized, TPS, Inc. and any 3rd party company from all liability and damages whatsoever in furnishing, obtaining, or using said information. Inthe event of employment, I understand that false or misleading information given in my application or interview(s) may result in immediate dismissal. - understand, also, that I am required to abide by all rules and regulations of TPS, Inc. Iunderstand and agree that if employed, the employment will be "at will". That is, either I or TPS, Inc. may end the employment relationship at any time, for any reason, or for no reason. I understand that receipt of this application by TPS, Inc. does not imply employment and that this application and/or any other TPS, Inc. documents are not contracts of employment.
APPLICANT'S SIGNATURE

Clear
What store are you applying to work at?

Store #10 - 4370 Evans to Locks Road, Evans, GA 30809Store #11 - 805 North Bypass East, Washington, GA 30673Store #18 - 5142 Washington Road, Evans, GA 30809I am willing to work at whichever store is hiring.
DATE SIGNED

Clear
Should be Empty:

EMPLOYMENT APPLICATION

FULL TIME EMPLOYMENT

PART TIME EMPLOYMENT