Application for Employment - MyJobApps.com

1 We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a disability or handicap, sexualorientation, or any other legally protected status. Any offer of Employment is contingent on a background and credit check and a negative drug screen InformationCurrent Date:First Last NameHome Phone NumberComplete Street AddressCityStateZip CodeAre you at least 16? Yes NoFor Lube & Tire: Are you at least 18 Yes Noand have a valid driver's license?If hired, can you provide evidence of your identity and your legal eligibility to work in the Yes NoAre you willing to submit to a drug test?

2 Yes NoWill you work Yes Noweekends?Do you have reliable transportation to work? Yes NoLocation Applying for (check at least one): Willkomm Companies PETRO Travel Store - Racine Iron Skillet - Racine PETRO:Lube - Racine Maintenance Custodial On the Run - Racine burger king - Racine Sports Plaza Mobil - 5205 Green Bay Rd - Kenosha Southport Mobil - 7318 75th St - Kenosha JWI Mobil Distribution Open to any LocationPosition Applying for (check at least one): Management Sales Associate Server Dishwasher Cook Food Prep Lube & Tire Tech Maintenance Truck Mechanic Service Advisor Bookkeeper Custodial Other Can you work any day, any shift?

3 Yes NoShift Preference: 1st shiftIf not, list when you CAN work:(Check all that apply) 2nd shift 3rd shiftAre you seeking (check all that apply): Full-Time Part-Time SeasonalHave you ever worked here before? Yes NoIf yes, please list department, position and dates: Application for EmploymentPlease read carefully, print, and fill out completelyPlease fax Application to: , email resume or Application to or apply in or missing information may disqualify your Application !PETRO Travel Store, PETRO:Lube, & Iron Skillet Restaurant - I-94 & Hwy 20 - Racine, WI Jerry Willkomm Inc - Somers, WISports Plaza Mobil - 5205 Green Bay Rd - Kenosha, WI Southport Mobil - 7318 75th St - Kenosha, WI Washington Ave Mobil - On the Run and burger king - 6840 Washington Ave - Racine, WIEmployment InformationStart with current or most recent NameCompany PhoneCompany Location: City and StateDates Employed (Month/Year)toSupervisor NameYour Job Title &/Or DutiesStart and End Pay/Why did you Leave (or want to leave if still working there)?

4 Was Termination voluntary?YesNoCompany NameCompany PhoneCompany Location: City and StateDates Employed (Month/Year)toSupervisor NameYour Job Title &/Or DutiesStart and End Pay/Why did you Leave (be specific)?Was Termination voluntary?YesNoCompany NameCompany PhoneCompany Location: City and StateDates Employed (Month/Year)toSupervisor NameYour Job Title &/Or DutiesStart and End Pay/Why did you Leave (be specific)?Was Termination voluntary?YesNoCompany NameCompany PhoneCompany Location: City and StateDates Employed (Month/Year)toSupervisor NameYour Job Title &/Or DutiesStart and End Pay/Why did you Leave (be specific)?

5 Was Termination voluntary?YesNoGeneral InformationHave you ever applied here before? Yes NoIf yes, please list department, position and dates:Please list anyone who works here or has worked here that you know or are related to:Have you ever been convicted of a felony or misdemeanor? (excluding minor traffic violations). Yes NoIf yes, please explain below, including date and type of conviction: (Applicants are not obligated todisclose expunged records or arrest or convictions.) Explanation:Have you ever been terminated from a position? If yes, please list and explain. Yes NoExplanation:Are there any employers we may NOT contact?

6 If yes, please list and explain. Yes NoPlease explain gaps between your jobs:Why should we offer you a position?Education InformationHow far did you get in school? (Check one): GED Some High School Some College High School Graduate College GraduateSpecial licenses, certificates, skills:Character ReferencesProfessional References OnlyName: Phone:How do you know this person?Years Known:Name: Phone:How do you know this person?Years Known:Name: Phone:How do you know this person?Years Known:If we ask your most recent supervisor to describe you in one sentence, what will he/she say?

7 (Write answer below)I certify that the facts set forth in this Application are true, correct and complete without misrepresentations or omissionsof any kind whatsoever. I authorize investigation of the statements I have made hereby release from any and all liability all representatives of WILLKOMM COMPANIES for their acts performed in connection with evaluating my Application , credentials and qualifications. I hereby further authorize any party (including the companies, schools and organizations listed in this Application form) to release any information they haveabout me to WILLKOMM COMPANIES, including my entire personnel file(s) with prior employers.

8 I also release from any and all persons, companies, schools and organizations (and all persons connected with them) who provide suchinformation to WILLKOMM COMPANIES, from all liability for any damages for giving this information. I understand that WILLKOMM COMPANIES has a NO SMOKING understand that if any of the information on this Application form is discovered to be incorrect, false or misleading, orif there are any misrepresentations or omissions of any kind whatsoever, then WILLKOMM COMPANIES may denyme Employment or terminate my Employment , and I agree that WILLKOMM COMPANIES shall not be liable in anyrespect if it does so.

9 Also, I understand that WILLKOMM COMPANIES will discharge or refuse to hire me becauseof my refusal to submit to a background and credit check, drug screen, tampering with the drug test sample or a positive drug screen SignatureDateFirst Interview:Start Date:Reference Checked:Job Title:Background Checked:Division:(Do not write below this line)Attention all Willkomm Companies Job ApplicantsPlease read, understand, sign and date if you agree:PETRO Travel Store, PETRO:Lube, & Iron Skillet Restaurant - I-94 & Hwy 20 - Racine, WI Jerry Willkomm Inc - Somers, WISports Plaza Mobil - 5205 Green Bay Rd - Kenosha, WI Southport Mobil - 7318 75th St - Kenosha, WI Washington Ave Mobil - On the Run and burger king - 6840 Washington Ave - Racine, WI