Application for Employment

To apply for employment please fill in the following and click submit.


Petro Mart I Blair, NE	Petro Mart II Blair, NE	Petro Mart Omaha Omaha, NE	Petro Mart Travel Plaza and Junction Cafe Missouri Valley, IA

First Name	Last Name	Social Security Number
Address	City	State	Zip Code
Home Phone	Business Phone	Are you 18 years of age or older? Yes No	Are you eligible to work in the United States? Yes No
Position applying for	Referred by	Have you ever applied to this company before? Yes No	Date available for work
Are you available to work holidays? Yes No	Are you available to work weekends? Yes No	Have you ever been convicted of a crime (other than traffic violations) or imprisoned within the past 7 years? Yes No If yes, please explain
Education
Name of school	Address of School	Years attended	Major	Degree Recieved
High School
College
Other
Employment History Begin with the most recent
Name and address of company	Dates of employment	Duties	Salary	Reason for leaving



Professional References
Name	Address	Telephone number	Relationship




Please click submit when finished
By submitting, I certify that all the above information on this form is correct.