Employment

Applicant Data

1. Name:
2. Telephone:
3. Email Address:
4. Social Security Number:
5. Current Address (Street, City, State, Zip):
6. Previous Address (Street, City, State, Zip):
7. Have you worked for Shell/East Side before? If yes, where?
8. Are you at least 18 years old?
   Yes No
9. Ever convicted of felony/misdemeanor? If yes, explain*:
   * Do not answer this question if applying in the state of MA.
10. Can you provide proof of legal right to work in the U.S.?
    Yes No
11. Do you have or can you get a valid drivers license?
    Yes No
12. Has your license ever been revoked? If yes, explain:
13. License number, State, and class:
14. Access to a properly insured vehicle?
    Yes No
15. Languages spoken besides English:

What You Are Looking For

1. Position Desired:
2. Salary Desired:
3. Date Available to Start:
4. Geographical Preferences:
5. Full/Part-Time:
   Full-Time Part-Time
6. Any future scheduled commitments?

Schedule Availability

7. From:

   To:

8. SUNDAY:
9. MONDAY:
10. TUESDAY:
11. WEDNESDAY:
12. THURSDAY:
13. FRIDAY:
14. SATURDAY:
15. Hours Desired per Week:

Employment History

Please list all jobs within the past 5 years, starting with the most recent. Account for all time periods, including unemployment, self-employment, U.S. military service, and verified work performed on a volunteer basis.

1. Company Name:
2. Type of Business:
3. Job Title:
4. Address:
5. Phone Number:
6. Hourly Rate:
7. Dates Employed (From/To):
8. Reason for Leaving:
9. Immediate Supervisor:

---

10. Company Name:
11. Type of Business:
12. Job Title:
13. Address:
14. Phone Number:
15. Hourly Rate:
16. Dates Employed (From/To):
17. Reason for Leaving:
18. Immediate Supervisor:

---

19. Company Name:
20. Type of Business:
21. Job Title:
22. Address:
23. Phone Number:
24. Hourly Rate:
25. Dates Employed (From/To):
26. Reason for Leaving:
27. Immediate Supervisor:

---

28. Company Name:
29. Type of Business:
30. Job Title:
31. Address:
32. Phone Number:
33. Hourly Rate:
34. Dates Employed (From/To):
35. Reason for Leaving:
36. Immediate Supervisor:
37.  
38.  
39. May all above employers be contacted for reference? If no for any, explain:
40. Explain any occasions you were involuntarily terminated from an employer:

Professional References

References cannot be members of your immediate family. Must have known each other for at least 3 years.

1. Name:
2. Phone Number:
3. Occupation:

---

4. Name:
5. Phone Number:
6. Occupation:

---

7. Name:
8. Phone Number:
9. Occupation:

Education History

1. School Name:
2. School Type:
   High School College University
3. Graduate:
   Yes No
4. Years Attended:

---

5. School Name:
6. School Type:
   High School College University
7. Graduate:
   Yes No
8. Years Attended:

---

9. School Name:
10. School Type:
    High School College University
11. Graduate:
    Yes No
12. Years Attended:

Employment Questions

1. 1. Are you willing to consent to a criminal background check?
   Yes No
2. 2. Are you willing to submit to a drug test?
   Yes No
3. 3. Are you willing to comply with our company's designated smoking area policy?
   Yes No
4. 4. Are you willing to keep your work area clean, which may include inside and outside maintenance?
   Yes No
5. 5. This job may require heavy lifting up to 50 lbs. Are you willing to do this?
   Yes No
6. 6. Are you willing to comply with company uniform policy of a uniform shirt, black pants, and a name tag visible at all times?
   Yes No
7. 7. Playing lottery while on duty is prohibited. Are you willing to comply with this company policy?
   Yes No
8. 8. Are you willing to only sell cigarettes, tobacco, lottery, alcohol to those old enough?
   Yes No
9. 9. Are you willing to limit cell phone use to emergencies only?
   Yes No

Non-Discrimination Hiring Policy

1. We are an equal opportunity employer and we do not discriminate in employment on the basis of race, color, creed, sex, national origin, age, religion, sexual preference, disability, or veteran status. A disabled applicant may request a reasonable accommodation in order to perform the essential functions and duties of the job.

Statement of Accuracy and Understanding

1. I certify that the answers set forth in my application are factual and complete to the best of my knowledge. I understand that, if employed, false statements or omissions on this application may be grounds for immediate termination of my employment. I authorize East Side Enterprises and affiliates to procure a consumer report on me in accordance with the requirements of the Fair Credit Reporting Act, Title 15, US Code. S 1618 et seq. Furthermore, I authorize East Side Enterprises and affiliates to check all personal and employment references, and to verify all of the information that I have included in this application.
2.  
3. I understand that I have the option to terminate my employment relationship with East Side Enterprises with or without cause and with or without notice at any time, while acknowledging that East Side Enterprises retains these same rights. I understand that if I am hired, all benefits, policies, practices, and procedures may be changed by East Side Enterprises at any time, with or without notice. I understand that this application, East Side Enterprise policies, practices, procedures, and all other communication distributed to me by East Side Enterprises, whether written or verbal, before or after employment, does not constitute or supplement any contract of employment. I further understand that no agent, employee, or representative of the company has the authority to make any promises or agreements contrary to the above policies, unless it is in writing and signed by the President of East Side Enterprises.
4.  

NOTE: THIS APPLICATION SHALL BE CONSIDERED ACTIVE UP TO 60 DAYS FROM THE ABOVE DATE.

5. Attach Resume:
   
6.  
7. 

   

   
   

   Type the text:
   
   
   
8.   Submit Application