Gas/Convenient Store

Employment Application
W4

Employment Application
w4

EMPLOYMENT APPLICATION

Applying for: *

Full Name *Your personal information is handled with strict confidentiality. We do not store your Social Security Number in our database. Once your application is submitted, all data is promptly removed from our system, and only a secure copy is delivered to our hiring team.

Street Address *

Apartment, suite, etc

City *

State *

ZIP Code *

Date of Birth *

Social Security Number *

Email Address *

Phone *

Date Available *

Desired Pay *

Per *HourlySalary

Position Applied For *

Employment Desired *Full-TimePart-TimeSeasonal

Are you legally eligible to work in the U.S? *YesNo

Have you ever worked for this employer? *YesNo

Please write the start and end dates: *

Have you ever been convicted of a felony? *YesNo

Please explain: *

High School:

City/State

From:

To:

Graduate?YesNo

Diploma

College:

City/State

From:

To:

Graduate?YesNo

Degree:

Other:

City/State:

From:

To:

Degree/Certificate:

Employer 1:Company/Individual

Email Address

Phone

City

State

Starting Pay: $

Ending Pay: $

Job Title:

Responsibilities:

From:

To:

Reason for Leaving:

Employer 2:Company/Individual

Email Address

Phone

City

State

Starting Pay: $

Ending Pay: $

Job Title:

Responsibilities:

From:

To:

Reason for Leaving:

Full Name *

Relationship: *

Company/Individual: *

Title: *

Email Address

Phone *

Full Name *

Relationship: *

Company/Individual: *

Title: *

Email Address

Phone *

Are you a Veteran? *YesNo

Branch: *

Rank at discharge: *

From: *

To: *

Type of Discharge:

If not Honorable, Please explain: *

If asked, are you willing to consent to a background check? *YesNo

Disclaimer *

Applicant understands that this is an Equal Opportunity Employer and committed to excellence through diversity. In order to ensure this application is acceptable, please print or type with the application being fully completed in order for it to be considered.

Please complete each section EVEN IF you decide to attach a resume.

I, the Applicant, certify that my answers are true and honest to the best of my knowledge. If this application leads to my eventual employment, I understand that any false or misleading information in my application or interview may result in my employment being terminated.

DIRECT DEPOSIT:

Please provide you bank information for direct deposit.

Bank Name

Routing Number

Confirm Routing Number

Account Number

Confirm Account Number

Upload your DL/State ID *

No file chosen

Your Name *

Today's Date

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