Employment Application

Grace Energy Corporation is an Equal Opportunity Employer.
Grace Energy Corporation is also a "Drug Free" Work Place

This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, age, creed, national origin or the presence of disabilities. Additional testing of job-related skills and for the presence of drugs will be required prior to employment. After an offer of employment, and prior to reporting to work, you may also be required to submit a medical review. Depending on company policy and the needs of the job, you may be required to complete a medical history form and may be required to be examined by a medical  professional designated by the company.

First name
Last name
Middle initial
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
FAX
E-mail

          Social Security Number
Are you over 18 years of age?

Availability

What position are you applying for?

What date can you start? -- mm/dd/yy

What store location are you applying to?

Have you ever worked for Fastrip, Snak-Atak, Pronto, Quick Stop or Uptown Laundromats?


Do you have any relatives working for Fastrip, Snak-Atak, Pronto, Quick Stop or Uptown Laundromats?


Education

Please check highest grade completed:

High School -(Name, City/State, Dates, Graduate?)


College:(Name, City/State, Dates, Graduate?)


Other:(Name, City/State, Dates, Graduate?)


Employment References

Most Recent Employer:(Company Name, City, State, Phone Number, Job Title, Supervisor Name, Duties, Salary, Reason for leaving)

Second Most Recent Employer:(Company Name, City, State, Phone Number, Job Title, Supervisor Name, Duties, Salary, Reason for leaving)

Third Most Recent Employer:(Company Name, City, State, Phone Number, Job Title, Supervisor Name, Duties, Salary, Reason for leaving)


References

Include only individuals familiar with your work ability.( Do not include relatives)

Reference #1:

First name
Last name
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone

Reference #2:

First name
Last name
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone

Comments:


Copyright(c) 1998, 1999 Grace Energy Corporation
Site Design by RB Associates
Last Edited on Friday, April 16, 1999


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