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Employment Application

Maxum Petroleum and its subsidiaries are equal opportunity employers and do not discriminate on the basis of age, race, religion, color, sex, national origin, sexual orientation, ancestry, military status, marital status or physical or mental disability. In compliance with the Immigration Reform and Control Act of 1988, we will hire only U.S. Citizens and Aliens lawfully authorized to work in the U.S. Should you be employed by Maxum Petroleum, you will be required to complete and sign Form I-9 Employment Eligibility Certification.

NAME:

(Last)

(First)

(Middle Initial)

(Date)

PRESENT ADDRESS:

(Street)

(City)

(State)

(Zip Code)

(Home Phone)

(Email)

(Cell Phone)

Permanent Address (if different from above)

(Street)

(City)

Are you legally authorized to work in the U.S. for any and all employers?

(State)

  • Yes

  • No

(Zip Code)

Are you at least 18 years old?

Have you previously applied for employment with Maxum or a subsidiary?

  • Yes

  • Yes

  • No

  • No

If yes, when?

_______________

Have you ever been employed by Maxum or a subsidiary?

  • Yes

  • No

If yes, when?

_______________

Name used during previous employment with Maxum or a subsidiary?

______________________________________________________

Position held:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Have you ever been convicted of a felony under any jurisdiction?

  • Yes

  • No

Conviction of a crime will not necessarily be a bar to employment. Factors such as age at the time of the offense, type of offense, remoteness of the offense in time, and rehabilitation will be taken into account in determining effect on suitability for employment."

Work Preferences

Position Desired:

(Title)

Employment Desired:

  • Full Time

  • Part Time

  • Temporary

(Desired Salary)

  • Seasonal

(Date Available)

Would you consider a contract assignment?

  • Yes

  • No

  • Possibly

What days and hours are you available for work? Days:__________________________________

Hours:

_________________________

Are you available for work on weekends, if necessary?

  • Yes

  • No

2011 Maxum Petroleum, Inc.

500 River East Drive | Belle, WV 25015 | (304) 926-3002 | www.maxumpetroleum.com

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