General Employment App Step 1 of 6 16% Name* First Middle Last Address* Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Home phoneCell phoneEmail Position applying forReferred ByType of positionFull TimePart TimeSeasonal/InternshipAvailable to work Days Days Evenings Weekends How did you learn about this opening?Date available for work Date Format: MM slash DD slash YYYY Have you ever been employed with us before?*YesNoStarting Salary ExpectationsAre you currently employed?*YesNoAre you at least 18 years of age?*YesNoAre you legally entitled to work in the United States?*YesNoAre you eligible to receive any and all permits/licenses by law?*YesNoHave you ever been discharged or asked to resign from a job?*YesNoAre you able to perform the essential functions of the job for which you are applying with or without reasonable accommodation?*YesNoIf no, describe the function(s) that cannot be performed. EducationSchool #1Name of school City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Grade(s) completedDid you graduate?Select...YesNoMajorSchool #2Name of school City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Grade(s) completedDid you graduate?Select...YesNoMajorSchool #3Name of school City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Grade(s) completedDid you graduate?Select...YesNoMajor Job-Related SkillsPlease answer the following if the position you are applying for involves these skills.Typing WPMTen Key Touch Sight Personal computer and software usedWord ProcessingSelect...YesNoOther computer skillsAccountingForeign Language (Indicate any that you can speak, read and/or write)Indicate any other skills related to the position you are seeking Employment HistoryYou must list all employment history for the last 10 years without omission beginning with the most recent in order for your application to be considered complete and acceptable by COI.Past Employer #1Company name City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific PhoneSupervisor nameOK to contact?Select...YesNoDates of employmentJob titleStarting pay rateEnding pay rateReason for leavingPast Employer #2Company name City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific PhoneSupervisor nameOK to contact?Select...YesNoDates of employmentJob titleStarting pay rateEnding pay rateReason for leavingPast Employer #3Company name City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific PhoneSupervisor nameOK to contact?Select...YesNoDates of employmentJob titleStarting pay rateEnding pay rateReason for leavingPast Employer #4Company name City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific PhoneSupervisor nameOK to contact?Select...YesNoDates of employmentJob titleStarting pay rateEnding pay rateReason for leaving Professional ReferencesReference #1Name First Last Address Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code PhoneOccupationYears knownReference #2Name First Last Address Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code PhoneOccupationYears knownReference #3Name First Last Address Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code PhoneOccupationYears known APPLICANT’S CERTIFICATION I certify that answers given herein are true and complete to the best of my knowledge. I also authorize Connell Oil, Incorporated (“company”) to investigate all statements contained in this application and to request information about me from previous employers, educational institutions, reviewing criminal conviction and driving records, and verifying any other relevant information about me. I expressly authorize my previous employers to provide information and opinions concerning my work and work habits. Further, I release all parties and persons connected with any requests for information from all claims, liabilities, and damages for whatever reason, arising out of furnishing any information that may be sought in arriving at an employment decision. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in dismissal. AT-WILL EMPLOYMENT I understand that if the company hires me, my employment is at-will, which means that it may be terminated by the company or me at any time, for any reason or no reason. I also understand that this employment at-will policy may not be modified except in writing by the CEO of the company. APPLICANT CONSENT TO DRUG TESTING I understand that a requirement for employment with Connell Oil Incorporated (“company”) is that I cooperate with and successfully complete drug screening for controlled substances. A positive test or lack of cooperation will disqualify me at this time from further consideration for employment and I will not be able to reapply for 6-months. Lack of cooperation includes alteration of my system or the specimen in a manner that prevents accurate testing, including but not limited to drinking excessive liquids. I understand and agree that any offer of employment which the company extends to me is conditioned upon my cooperation and satisfactory results from the drug testing; and if I begin work prior to taking this test or the results of the tests having been received, my employment is contingent on those results. The sample collection, supervision of chain of custody, and testing procedures will be handled by an outside service designated by the company in a manner to insure, to the maximum practical extent, the objectivity and integrity of the process. If there is reason to believe you tamper with, adulterate or in any other way attempt to dilute the specimen, the second specimen will be collected under direct observation of a same gender collection person. By my signature I hereby agree, in the event that I am offered a position with the company, to provide a sample at the designated facility and agree and consent to have such sample tested for the presence of controlled substances. I authorize the release of test results to the company for its use in evaluating me for employment. I release the company from any and all liability and claims incident to the sample taking, testing and the use of the test results.* I Agree
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