Print Job Application Join Our Team Step 1 of 4 25% Name: First Last Have you ever been identified by any other name? If so, please list:(For example: Your Maiden Name)Present Address: Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country How long at this addressCurrent Telephone NumberAlternate Contact Number:Best Time to Call: : Hour Minute AM PM Application For Employment with: Shawley's Superior LP Gas So-Fine, Inc. Shawley's Inc./Bloom Oil Shawley's Hardware, Inc. How many years of experience do you have?What drivers license or endorsements do you hold?Please separate with commasWhat job are you seeking to be hired for?Why do you think you would be good for this job?Email Address: Type of Employment Desired: Full-Time Part-Time Temp Are You Employed Now?: Yes No Have you ever been employed by Shawley's?: Yes No If Yes, Provide Date, Location, PositionStart Date: Date Format: MM slash DD slash YYYY End Date: Date Format: MM slash DD slash YYYY Location: Shawley's Superior LP Gas So-Fine, Inc. Shawley's Inc./Bloom Oil Shawley's Hardware, Inc. Position:Date Available to Start Work: Date Format: MM slash DD slash YYYY Expected Salary:Can You Work Overtime? Relocate (if necessary)? Travel (if necessary)? Check all that applyDo you have any relatives who are currently employees of the company? Yes No If Yes, list the name(s) & relationship(s)Name 1: First Last Relationship 1:Name 2: First Last Relationship 2:Name 3: First Last Relationship 3: Are you 18 years of age or older?: Yes No Please note that the Shawley's complies with the state and federal laws which prohibit discrimination based on age.If "No", can you provide a valid work permit?: Yes No Are you currently authorized to work in the United States?: Yes No Proof of eligibility will be required if employment is offered.Have you ever pled "Guilty" or "No Contest" to, or been convicted of a misdemeanor or felony? Yes - Give Dates / Details No If Yes please give dates and details:How did you hear about us? Employee* Newspaper Advertisement* Website Walk in Employment Agency* Internet Advertisement* Other* Name of Source:EducationName of High School:Location of High School: City State / Province / Region Graduated?: Yes No GED?: Yes No Name of College / Trade or Business SchoolLocation: City State / Province / Region Major/EmphasisDegree or Certification Earned:*INSERT THE NUMBER OF COLLEGE CREDIT HOURS COMPLETED IF NO DEGREE OR CERTIFICATE WAS OBTAINED.Name of College / Trade or Business SchoolLocation: City State / Province / Region Major/EmphasisDegree or Certification Earned:*INSERT THE NUMBER OF COLLEGE CREDIT HOURS COMPLETED IF NO DEGREE OR CERTIFICATE WAS OBTAINED.Name of College / Trade or Business SchoolLocation: City State / Province / Region Major/EmphasisDegree or Certification Earned:*INSERT THE NUMBER OF COLLEGE CREDIT HOURS COMPLETED IF NO DEGREE OR CERTIFICATE WAS OBTAINED.Name of College / Trade or Business SchoolLocation: City State / Province / Region Major/EmphasisDegree or Certification Earned:*INSERT THE NUMBER OF COLLEGE CREDIT HOURS COMPLETED IF NO DEGREE OR CERTIFICATE WAS OBTAINED.List school honors, scholarships, and extra curricular activities (optional)Do not need to include those that identify your race, religion, national origin, sex, age, sexual orientation, marital status, disability or union affiliation.List equipment & software expertise/proficiency:List professional certificates, licenses, or business associations: Employment HistoryPlease provide your full employment history. If greater than 10 years of history, you must include a minimum of 10 years. * List employers starting from the most recent. * For any unemployed or self-employed periods, show dates and locations. * All information, including salary history, must be completed. Please insert “n/a” in any block that is not applicable. * A resume will not be accepted in lieu of completion of all, or any part of this form. Consequently, please do not insert "See Resume" in any section below. Applicants wishing to submit a resume may do so, in addition to this employment application.Are you under a technical contract or employment restriction with a former employer?: Yes No If Yes, with whom?Employer 1Name of Employer:Address Street Address City State / Province / Region ZIP / Postal Code Is this employer in the propane services industry?: Yes No May we contact employer now?: Yes No Phone Number:Starting Date Date Format: MM slash DD slash YYYY Starting Salary:Please indicate whether its Hourly, Monthly, YearlyCommission/Other Compensation:Starting Position:End Date: Date Format: MM slash DD slash YYYY Present/Ending Salary:Please indicate whether its Hourly, Monthly, YearlyCommission/Other Compensation:Present/Ending Position:Name & title of supervisor (for last position held):Reason for leaving or desiring to leave:Were you subject to Federal Motor Carrier Safety Regulations while employed by this employer?: Yes No Was this job designated as a safety sensitive function in any DOT regulated mode subject to alcohol & controlled substance testing?: Yes No Brief description of your responsibilities:Employer 2Name of Employer:Address Street Address City State / Province / Region ZIP / Postal Code Is this employer in the propane services industry?: Yes No May we contact employer now?: Yes No Phone Number:Starting Date Date Format: MM slash DD slash YYYY Starting Salary:Please indicate whether its Hourly, Monthly, YearlyCommission/Other Compensation:Starting Position:End Date: Date Format: MM slash DD slash YYYY Present/Ending Salary:Please indicate whether its Hourly, Monthly, YearlyCommission/Other Compensation:Present/Ending Position:Name & title of supervisor (for last position held):Reason for leaving or desiring to leave:Were you subject to Federal Motor Carrier Safety Regulations while employed by this employer?: Yes No Was this job designated as a safety sensitive function in any DOT regulated mode subject to alcohol & controlled substance testing?: Yes No Brief description of your responsibilities:Employer 3Name of Employer:Address Street Address City State / Province / Region ZIP / Postal Code Is this employer in the propane services industry?: Yes No May we contact employer now?: Yes No Phone Number:Starting Date Date Format: MM slash DD slash YYYY Starting Salary:Please indicate whether its Hourly, Monthly, YearlyCommission/Other Compensation:Starting Position:End Date: Date Format: MM slash DD slash YYYY Present/Ending Salary:Please indicate whether its Hourly, Monthly, YearlyCommission/Other Compensation:Present/Ending Position:Name & title of supervisor (for last position held):Reason for leaving or desiring to leave:Were you subject to Federal Motor Carrier Safety Regulations while employed by this employer?: Yes No Was this job designated as a safety sensitive function in any DOT regulated mode subject to alcohol & controlled substance testing?: Yes No Brief description of your responsibilities:Business Related ReferencesList two business-related references that the Company may contact, such as former or present co-workers or supervisors. Do not list relatives or supervisors that you listed under Employment History section. Please provide complete names, addresses, and telephone numbers to facilitate our contact with these references.Name First Last Address Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Business RelationshipHome Phone (include area code)Daytime Phone (include area code)Name First Last Address Street Address City State / Province / Region ZIP / Postal Code Business RelationshipHome Phone (include area code)Daytime Phone (include area code) Agreement And ReleaseIf hired, I agree to abide by all of the Company's rules and regulations, and understand that, if employed, my employment may be terminated with or without cause, and with or without notice, at any time, at the option of either the Company or me. I further understand that no representation, whether oral or written by any representative or agent of the Company, at any time, can constitute a contract of employment. I understand that the Company shall have the maximum discretion permitted by law, to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures, benefits or other terms or conditions of employment. No representative or agent of the company has the authority to enter into any agreement for employment for any specified period of time, or to make any change in any policy, procedure, benefit or other term or condition of employment, other than in a document signed by the President and Chief Executive Officer, or to make any agreement contrary to the foregoing. If employed, I agree to engage in no outside activity which would involve a material conflict of interest with, or which could reflect adversely on, the Company. understand the decision of conflict of interest rests with the Company. If employed, I agree to hold in strictest confidence, all information concerning the Company, its Insureds, and its Agents which may come to my knowledge. I understand that completion of this Application For Employment does not guarantee that I will be employed by this Company. I hereby affirm that all information I have provided in order to apply for and secure work with the Company is complete, true and correct to the best of my knowledge. By my signature below, I grant permission to the Company to verify all information that has been requested by the Company in this Application for Employment, and to obtain reference and prior pay history information. I have not knowingly withheld any fact or circumstance that would, if disclosed, affect my application unfavorably. I understand that the Company may require the successful completion of a drug/alcohol test and/or an acceptable criminal, credit, and/or motor vehicle report as a condition of employment. By submitting this Application for Employment, I hereby consent to such tests or background checks, at the Company's discretion. I understand that any misrepresentation, deception, or false statement made in this Employment Application, may result in my not being considered for employment, and if not discovered by the Company until after my becoming employed, is grounds for, and may result in, my immediate termination from employment. I understand that this application remains current for only 30 days, or until the position for which I have applied has been filled or the Company makes the decision not to fill the position, whichever is sooner. At the conclusion of that time, if I have not heard from the Company and still wish to be considered for employment, it will be necessary for me to reapply by completing a new application. I understand all offers of employment are conditional upon satisfactory reference and background checks, drug/alcohol test, successful completion of a preplacement health evaluation, and/or work performance assessment, if required. I understand if hired I must produce documents required by law (form DHS I-9) to verify my identity and work authorization; and that I must complete the Company's standard employee agreements including but not limited to Employee Handbook. If an employment offer is extended to me and accepted, I understand that I must fully adhere to the policies, rules and regulations of employment the Company. However, I further understand that neither the policies, rules, regulations, employment or anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered, is for an indefinite duration and is at will, and that either I or the Company may terminate my employment at any time, with or without notice or cause.If you have a resume please attach it here in PDF format*I CERTIFY THAT I HAVE READ, FULLY UNDERSTAND AND ACCEPT ALL TERMS OF THE FOREGOING AGREEMENT AND RELEASE. I agree to all termsSignature*Please type your nameDate*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920The policy of Shawley's. and its subsidiaries is to provide equal opportunity to all persons without regard to race, color, sex, religion, sexual preference, national origin, age, Vietnam era/disabled veteran status, disability, or other bases prohibited by applicable law. The policies of Shawley's prohibit harassment of applicants employees related to these bases.
