Submit Application | Speedee Mart

Submit Application

Name

First Name: *

Last Name: *

Middle Initial: *

Suffix:

Personal Information

Daytime Phone: *

Cell Phone:

Evening Phone: *

Current Address

Address: *

Address continued:

Apt/suite number:

City: *

State: *

ZIP: *

Previous Address

Address:

Address continued:

Apt/suite number:

City:

State:

ZIP:

Age Range: *

List any relative/friends working for us:

Drivers License Number:

Drivers License State:

email:

Availability

Type of position wanted:

How Many Years Do You Estimate That You Will Be Available For Work In this Area: *

Less Than 1 Year

1-2 Years

2-4 Years

5 Years Or Longer

Times Available:

Total Hours Available Per Week:

Date Available To Start:

Availability: *

Full Time

Part Time

Temporary

Desired Location - First Choice: *

Desired Location - Second Choice:

Desired Location - Third Choice:

Education

Highest Level of Education: *

School:

Year Completed:

Indicate Special Qualifications or Skills:

Military Experience

Military Service: Were You In U.S. Armed Forces?: *

Yes

No

Branch:

Length Of Service::

Rank At Discharge:

History

Have you ever been convicted of any crime, including a misdemeanor and/or felony in the past seven years?: *

If Yes, for what offenses have you been convicted? When and Where?:

The existence of a conviction record(s) does not constitute an automatic bar to employment. Your conviction record(s) will be considered only as it may substantially relate to the job for which you are applying.

Previous Speedee Mart Employment

Have you worked for Speedee Mart before: *

no

yes

If so, where and what dates:

Reason For Leaving:

Previous Employer 1

Supervisor's Name:

Salary: $

Reason for leaving:

Employer Phone:

Dates Employed:

Type of Business & Work Duties:

Employer Address:

Previous Employer 2

Supervisor's Name:

Salary: $

Reason for leaving:

Employer Phone:

Dates Employed:

Type of Business & Work Duties:

Employer Address:

Previous Employer 3

Supervisor's Name:

Salary: $

Reason for leaving:

Employer Phone:

Dates Employed:

Type of Business & Work Duties:

Employer Address:

Previous Employer 4

Supervisor's Name:

Employer Salary: $

Reason for leaving:

Employer Phone:

Dates Employed:

Type of Business & Work Duties:

Employer Address:

References

Personal only please. Do not list relatives.

Reference Name 1: *

Reference Address 1: *

Reference Occupation 1: *

Reference Years Known 1: *

Reference Phone 1: *

References 2

Reference Name 2: *

Reference Address 2: *

Reference Occupation 2: *

Reference Years Known 2: *

Reference Phone 2: *

References 3

Reference Name 3:

Reference Address 3:

Reference Occupation 3:

Reference Years Known 3:

Reference Phone 3:

Additional Information

In addition to your work history, list any other job-related experiences skills or qualifications you would like us to consider.:

Comments:

Authorization - Read Carefully

I certify that all of the information provided on this application is true to the best of my knowledge. I understand that Speedee Mart will look to verify the information I have provided in this application for employment and that Speedee Mart,. may conduct an investigation regarding my background. I authorize all persons, schools, companies and law enforcement agencies to release any information concerning my background to Speedee Mart I understand that employment at Speedee Mart. is "at will", which means that either the Company or I can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager or executive of the Company, other than the president has any authority to alter the foregoing. I understand that this application is kept on file for one year. Security and privacy are our top priorities and we are doing our best to preserve your privacy and to make sure your data is available only to the intended parties. No others shall be granted access to your data unless required by law. Data is collected and used for the sole purpose of facilitating the application/hiring process. In no event shall the developers or the sponsors or the service providers be liable for any damages this database might cause. Users (including applicants, referees, employers and others) are solely responsible for the appropriateness, completeness, correctness and lawfulness of their data. This service is provided without any warranty (either expressed or implied, including, but not limited to, the implied warranties of merchantability and fitness for a particular purpose).

I have read, understood and have agreed to, all of the statements above.: *

yes