Application – Clinton – Lee's Travel Center

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APPLICATION FOR EMPLOYMENT

To apply online, please fill out the form below and click submit at the bottom of the form.

First Name *

Last Name *

Date of Birth *

Address 1 *

Address 2

City *

State

Zip / Post Code

Phone *

Email *

Date Available for Employment

General Questions

What location are you applying for? *

If employed and under 18, can you furnish a work permit? Please Select. *

I'm over 18
Yes
No

Have you ever been employed by this company? Please Select. *

If yes, where and reason for leaving?

Are you currently Employed? *

If Employed, may we contact your current employer?

Unemployed
Yes
No

Are you prevented from lawfully becoming employed in this country because of visa or immgration status? *

Do you have a valid drivers license? *

If yes, what state?

Have you ever been convicted of a felony? *

If yes to felony conviction, please explain.

Education Questions

High School Attended?

Years High School Attended?

Did you graduate from High School? *

College Attended?

Years College Attended?

Did you graduate from College? *

Please list other education.

Year other education attended?

Did you graduate from other education? *

References

List three (3), non-relatives, who are familiar with your qualifications, work history and ability.

Please provide Name, Occupation/Relationship, Years Known, and Contact Number.

Reference 1

Reference 2

Reference 3

Prior Employment Experience

Employer

Supervisor

Employment Location

Employment Telephone

Job Responsibilities

When were you employed?

Starting Pay Rate?

Ending Pay Rate?

What did you like most about your job?

Reason for leaving?

TERMS OF SUBMITTING APPLICATION

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE SIGNING THIS APPLICATION. ONLY THOSE APPLICATIONS THAT ARE SIGNED AND DATED ARE CONSIDERED VALID. IF YOU HAVE ANY QUESTIONS REGARDING THIS STATEMENT, PLEASE ASK THEM BEFORE SIGNING.

I certify that all answers and statements I have made on this application are true and complete without omissions. By signing below, I authorize Lee’s Travel Center to investigate all statements contained in this employment application as they may deem necessary in arriving at an employment decision. I understand that any false information provided by me will likely result in a refusal to hire or immediate discharge if I am employed. I authorize any of the persons or organizations named in this application to give you complete information and records regarding my employment, education, character and qualifications.

If hired I will be responsible for familiarizing myself with all rules and regulations of Lee’s Travel Center as they presently exist or are later modified. If hired, I understand my employment can be terminated, at the discretion of Lee’s Travel Center or at my option, without notice, at any time and for any reason. I understand this application is not an offer of employment and no promises or representations of employment have been made to me at this time.

I have read, understand and agree with the above. *

By checking this box you digitally apend your signature to this application. *

This company is an equal employment opportunity employer. All applicants will be considered without regard of age, race, national origin, religion, disability, sex or other protected status in accordance with applicable federal and state equal employment opportunity laws. This company will strive to accommodate any physical or mental limitations of employees or applicants in order to accomplish the essential functions of the job.