Careers APPLICATION FOR EMPLOYMENT EMPLOYMENT APPLICATION Applications are considered without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a non-job-related medical condition or handicap. APPLICATION LOCATION What location are you applying for? Select Location Obies Mesa Marin Chevron Obies Downtown Shell Any Location PERSONAL INFORMATION Application Date Available Start Date Employment Type Full TimePart TimeTemporary Referral Source First Name Last Name Street Address City / State / Zip Phone Number Email SSN DOB BACKGROUND QUESTION Have you, or any person or entity with whom you have been associated with, filed for bankruptcy, been declared bankrupt or insolvent, or been the subject of any receivership proceedings within the last 7 years? YesNo If Yes, provide full details including dates, places, amounts involved and disposition EDUCATION School / College 1 School / College Attended # Years Year Grad Degree School / College 2 School / College Attended # Years Year Grad Degree School / College 3 School / College Attended # Years Year Grad Degree EMPLOYMENT / WORK EXPERIENCE Start with your present or most recent position. Include military service assignments and volunteer activities. Employer 1 Employer Job Title Supervisor Phone Street Address City / State / Zip From Month/Year To Month/Year Describe Duties / Responsibilities / Accomplishments Reason for Leaving Employer 2 Employer Job Title Supervisor Phone Street Address City / State / Zip From Month/Year To Month/Year Describe Duties / Responsibilities / Accomplishments Reason for Leaving PERSONAL REFERENCES Please provide names, addresses, phone numbers, relationship, and how long known for 3 personal references. Reference 1 Name Relationship Street Address City / State / Zip Phone How Long Known Reference 2 Name Relationship Street Address City / State / Zip Phone How Long Known Reference 3 Name Relationship Street Address City / State / Zip Phone How Long Known CERTIFICATION I CERTIFY that the above answers are true and complete to the best of my knowledge. I authorize Obie’s to investigate any statement contained in this application as necessary to determine my qualifications. I understand that this application is not and is not intended to be any kind of contract or agreement. In the event of employment, I understand that any false or misleading information given in my application, correspondence, discussions or interview may result in immediate termination. I understand also that I am required to abide by all rules, regulations and policies of Obie’s. Applicant Signature Clear Signature Signed Date
