APPLICATION FOR EMPLOYMENT

The following information is requested in order to help us make the best placement within the company. All portions of this application pertaining to you must be completed. We appreciate the time you spend in filling in this application form. AMPOL, in accordance with the State and Federal laws, does not discriminate on the bases of age, religion, sex, national origin, marital status, physical or mental handicap or arrest record.

    APPLICATION DATE


    PERSONAL INFORMATION








    ADDRESS












    Do you have a valid driver’s license?

    Have any licenses, permits, or privileges ever been suspended or revoked?

    Have you ever applied for employment at AMPOL?

    If yes, When?

    Have you ever been employed at AMPOL?

    If yes, When?

    Are you related to any AMPOL employee?

    If yes, Give name:
    Relationship
    Department

    Have you been convicted of a felony offense?
    A conviction does not automatically disqualify you from employment. The date, nature and seriousness of the offence will be considered in relation to specific job requirements.

    If yes, indicate type(s) and date(s) of conviction

    Job Requirements

    Position applied for:

    Desired duration

    Are you willing to work additional hours?

    Nights?

    Weekends?

    Holidays?

    Are you able to work away from home for at least two or more weeks at a time?





    EDUCATION

























    EMPLOYMENT RECORD

    (Required to be filled out completely)
    Please list experience from the past 10 years, beginning with the most recent. (Please attach additional sheets if required.)