Date of Application

MM

DD

YYYY

Date Available for Hire

MM

DD

YYYY

Can you work overtime, weekends?

Yes

No

Are you willing to work in other Pocket's?

Yes

No

Name *

First Name

Last Name

Current Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Alternate Phone

(###)

###

####

Are you at least 18 years old?

Yes

No

Are you a previous Pocket's employee?

Yes

No

Are you legally eligible to work in the US?

If offered employment, you will be required to provide proper documents to verify

Yes

No

Are you able, with or without reasonable accommodation, to perform essential functions of this job? If you have questions about the functions of the job, please ask the interviewer before answering this question.

Yes

No

Have you ever been discharged or asked to resign from a job?

If yes, please explain

Yes

No

Have you ever been convicted of a crime?

If yes, please explain

Yes

No

I certify all information given by me on this application is correct, true and complete. I understand that falsification of any information may be considered sufficient cause to cancel further consideration, or immediate discharge of the employer’s service. I authorize KY Lake Oil Company to verify all statements and make necessary reference checks. I understand if I am hired, I am free to end the employment at any time, for any reason. However, the company also reserves the right to terminate the employment relationship at any time, for any lawful reason. I understand if I am hired, I will be required to provide proof of identity and legal authority to work in the U.S. I certify I have read, fully understand and accept all the terms of the employment application.

I agree

I do not agree