Online Application

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Please select the one store you want to applying to.

New Hampshire Choices:

New York Choices:

Vermont Choices:


Personal Info:

First Name:

Last Name:

Middle Name:

Date:

Street Address:

City, State, Zip:

Home Phone:

Business Phone:


Have you Ever applied for Employment with us?
Yes No

If yes, Month and Year:

If yes, Location:


Position Desired:

Pay Expected:


Apart from the absence for religious observance, are you available for full-time work?
Yes No

If not, what hours can you work?

When will you be available to begin work?


Are you legally eligible for employment in the United States?
Yes No


Have you been convicted of any crimes in the past 10 years, excluding misdemeanors and summary offenses, which have not been annulled, expunged, or sealed by a court?
Yes No

If yes, describe in full:

Have you ever been Bonded?
Yes No

If yes, with what employers?


Other Special Training or Skills (Languages, Machine Operation, Ect.):


Education:

Please fill out the boxes below as best you can:

Elementary School:

Name and Location of School:

Course of Study:

Number of Years Completed:

Did you Graduate?
Yes No

Degree or Diploma?

High School:

Name and Location of School:

Course of Study:

Number of Years Completed:

Did you Graduate?
Yes No

Degree or Diploma?

Business/Trade/Technical School:

Name and Location of School:

Course of Study:

Number of Years Completed:

Did you Graduate?
Yes No

Degree or Diploma?

College:

Name and Location of College:

Course of Study:

Number of Years Completed:

Did you Graduate?
Yes No

Degree or Diploma?

Graduate School:

Name and Location of School:

Course of Study:

Number of Years Completed:

Did you Graduate?
Yes No

Degree or Diploma?


 

 

Employment:

Please give accurate, complete full-time and part-time employment records. Start with your present or most recent employer and work back.

Most Recent Employer

Company Name:

Company Number:

Address:

Supervisor’s Name:

Starting Date:

Ending Date:

Starting Weekly Pay:

Ending Weekly Pay:

State Job Title and Describe Your Work:

Reason for Leaving:


 

Next Most Recent Employer

Company Name:

Company Number:

Address:

Supervisor’s Name:

Starting Date:

Ending Date:

Starting Weekly Pay:

Ending Weekly Pay:

State Job Title and Describe Your Work:

Reason for Leaving:


 

Next Most Recent Employer

Company Name:

Company Number:

Address:

Supervisor’s Name:

Starting Date:

Ending Date:

Starting Weekly Pay:

Ending Weekly Pay:

State Job Title and Describe Your Work:

Reason for Leaving:


 

Next Most Recent Employer

Company Name:

Company Number:

Address:

Supervisor’s Name:

Starting Date:

Ending Date:

Starting Weekly Pay:

Ending Weekly Pay:

State Job Title and Describe Your Work:

Reason for Leaving:


 

Contact Permission

We may contact the employers listed above unless you indicate those you do not want us to contact.

 

Please list any and all of the employers listed above that you do not want us to contact. Be sure to provide the reason you wish for us to not contact them.


 

Military

 

Did you serve in the U.S. Armed Forces?
Yes No

If yes, in what Branch?

Describe any training received relevant to the position for which you are applying.


 

Personal References

 

Please do not list any relatives

 

Reference 1

Name:

Address:

Telephone Number:


Reference 2

Name:

Address:

Telephone Number:


Reference 3

Name:

Address:

Telephone Number:


Reference 4

Name:

Address:

Telephone Number:


Have you ever been convicted of a criminal offense?
Yes No

If yes, list charges and dates:


Have you ever been convicted of a motor vehicle offense?
Yes No

If yes, list charges and dates:


I am a U.S. Citizen over the age of 18
Yes No


I understand the duties of the job as described and certify that I am able to perform them ______ assistance.
Without With


Emergency Contact:

Name:

Telephone Number:

Relationship:


Notice! Please Read Carefully:

By submitting this form you consent to the release of information about my ability, work history, and any other pertinent information upon my termination.

 

I understand that Jolley Associates (or one of its subsidiaries) will attempt to verify statements made on this application and made during any employment interview. I give permission for my former educational institutions, employers and personal references to answer any and all questions based on the information available to them. I also authorize a criminal, drivers license history and credit history be performed as part of my reference information.

 

I understand that my failure to sign this release so that Jolley Associates can contact references and do a background check will be deemed interference with and a withdrawal of my application for employment.

 

I understand that false, incomplete or misleading statements or omissions on this application or any other pre or post employment form may be considered sufficient cause for dismissal. I understand that if I am employed by Jolley Associates I will conform to the rules of the company.

 

I understand that I have the right to terminate my employment at any time with or without notice and that Jolley Associates has a similar right.

 

I understand that I may be required to submit to substance testing at hire or at any time in the future with just cause and I agree to such testing.

 

I have read and agree with all of the content above.


 

Sister Companies:

SB Collins Logo

A locally owned petroleum products company located in Saint Albans Vermont. Delivering Gasoline and diesel to dealers in Vermont and New York.

Clarence Brown Logo

A locally owned home heating fuel oil Company located in Saint Albans Vermont. Serving thousands of homes and farms in northwestern Vermont.

 
 

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