Job Application for Corner Store Travel Center
Name
*
First Name
Last Name
Birthday
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Shirt Size
*
Please Select
XS
S
M
L
XL
2XL
3XL
Position Applying For
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Kitchen Staff
Janitorial Staff
Cashier
Overnight Cashier
I am able to work (select ALL that apply)
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Morning Shift (6 am - 2 pm)
Afternoon Shift (2 pm - 10 pm)
Overnight (10 pm - 6 am)
I was referred by:
Earliest Possible Start Date
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-
Month
-
Day
Year
Date
Preferred Interview Date
Upload Resume
Upload a File
Drag and drop files here
Choose a file
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Next
We are open 24/7 which includes ALL holidays. Are you able to work holidays as needed?
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Yes
No
Do you currently have any relatives and/or friends that work at Corner Store?
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Yes
No
If yes, what are their names?
Employment History
List your current or most recent employment
Are you currently employed?
*
Please Select
Yes
No
May we contact your current or most recent employer?
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Yes
No
If no, please explain:
Name of Company currently or most recently employed with
*
What is/was your title/position with this employer?
*
Who is/was your manager?
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Business Phone Number
*
How long were you employed here
*
What was/is your hourly pay/salary
*
How many hours did you work weekly
*
Reason for leaving
*
Other Past Employers
Company
Position
Time worked there
Hourly Rate
Reason for leaving
Please list any other jobs or qualifications you have
*
Education
Did you finish High School?
*
Yes I graduated
No I didn't
I am currently in High School
If yes, what year did you graduate?
*
Professional Reference
co-worker, past employer, boss etc.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship
*
co-worker, past employer, boss etc.
Years Known
*
May we contact?
*
Yes
No
If no, list reason why
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1. Are you authorized to work in the United States?
*
Please Select
Yes
No
2. What can you provide as proof of eligibility of employment?
*
Please Select
ITIN#
SSN
Other
If other, please list
3. Do you have adequate transportation to meet travel requirements for this position?
*
Please Select
Yes
No
4. Are you able and wiling to travel for this job if necessary?
*
Please Select
Yes
No
5. Are you aware of any reason that may restrict your ability to perform the essential functions of the job for which you are applying?
*
Please Select
Yes
No
If answered yes, please explain
6. Have you ever been terminated or forced to resign from your employment with any employer?
*
Please Select
Yes
No
If answered yes, please explain
7. During the past five years have you been convicted of, or have you plead guilted or no contest to a felony offense?
*
Please Select
Yes
No
If answered yes, please explain
If asked, are you willing to consent to a background check?
*
Yes
No
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Emergency Contact
*
First Name
Last Name
Relationship
*
Please Select
Spouse
Partner
Parent
Relative
Friend
Other
Phone Number
*
Format: (000) 000-0000.
Disclaimer
I certify that I have fully and accurately answered all questions and have given all information requested in this application for employment. I understand that any wrong or incomplete information on this application 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. If I am hired I understand that my employment will be at will, and either I or Corner Store may terminate my employment at anytime, with or with notice or reason.
Signature
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