First, Middle, and Last Name:
Position Applied For:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Shift:
Date Available to Start:
Email Address:
Address:
City, State, and Zip code:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Contact Number:
Secondary Contact Number:
Social Security Number:
How Did You Hear About Us?:
Are you legally eligible to work
Are you over the age of 18 years?
Are you over the age of 21 years?
Can you, with or without reasonable accommodation,
Have you ever applied to Maverik, Inc. before?
If yes, please give date.
Have you ever worked for Maverik, Inc. before?
If yes, please give date.
Have you ever been convicted of a
If yes, please explain:
Do you have a driver's license?
Is anyone related to you
If yes, please give their name and
Have you ever been fired or asked
If yes, please explain:
(If employed, I will notify my supervisor in writing, should my availabililty change.)
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Please list any academic honors, scholarships, offices held, etc. (Do not list any which reflect your race, color, religion, gender, national origin, age, disabilities, or veteran status.)
Describe any specialized training, apprenticeships, licenses or skills.
(Begin with current or more recent employer. Do not exclude any employment. Include any applicable temporary employment. Attach another sheet if necessary.)
Company Name:
Employment Dates From / To:
Salary Start / End:
Supervisor:
Address
Phone
Describe your duties:
Reason for leaving and explanation:
Company Name:
Employment Dates From / To:
Salary Start / End:
Supervisor:
Address
Phone
Describe your duties:
Reason for leaving and explanation:
Company Name:
Employment Dates From / To:
Salary Start / End:
Supervisor:
Address
Phone
Describe your duties:
Reason for leaving and explanation:
(Please list three persons, who are not related to you, who can provide references.)
Name:
Address:
Phone:
Relationship:
Years Known:
Name:
Address:
Phone:
Relationship:
Years Known:
Name:
Address:
Phone:
Relationship:
Years Known:
You may paste your cover letter and/or resume in the section below:
*PLEASE READ CAREFULLY BEFORE SUBMITTING APPLICATION*
I hereby certify that all of the information provided by me in this application (or any accompanying or required documents) is correct, accurate and complete to the best of my knowledge.
I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination regardless of the timing or circumstance of discovery.
I understand that submission of an application does not guarantee employment.
I further understand that, should an offer of employment be extended by Maverik, Inc. that such employment is at will, for no specified duration and may be terminated by either Maverik, Inc., or myself at any time, with or without cause or notice.
I understand that none of the documents, policies, procedures, actions, statements of Maverik, Inc. or its representatives used during the employment process is deemed a contract of employment, real or implied.
I understand that no representative of Maverik, Inc. except the President has the authority to enter into any agreement guaranteeing any conditions of employment or any agreement contrary to the foregoing statements and that any such agreements must be made in writing and signed by the President of Maverik, Inc..
In consideration for employment with Maverik, Inc., if employed, I agree to conform to the rules, regulations, policies and procedures of Maverik, Inc. at all times and understand that such obedience is a condition of employment.
I understand that due to the nature of Maverik, Inc.'s business, attendance and punctuality are considered essential requirements of every job at Maverik, Inc., and that poor attendance or tardiness will result in disciplinary action up to and including termination.
I understand that if offered a position with Maverik, Inc., I may be required to submit to pre-employment drug screening and background check as a condition of employment.
I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these pre-employment tests and checks will result in withdrawal of any employment offer or termination of employment if already employed.
I hereby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to Maverik, Inc. and/or any of its representatives, agents or vendors and I release all parties involved from any and all liability for any and all damage that may result from providing such information.
I understand that this application is considered current for three months.
If I wish to be considered for employment after this period I must fill out and submit a new application.
