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Work Experience

This portion of the application must be completed even if supplemented by a resume. List jobs in reverse order held present or most recent first. For periods of unemployment or self-employment, list dates and location. Please attach additional pages if necessary.

MOST RECENT EMPLOYER:

Dates of Employment:

___________________________________________________________________

(Name)

(Phone)

___________________________________________________________________

(Street)

(City)

(State)

From:

To:

Salary:

Starting:$

Ending:$

  • Full-time

  • Part-time

  • Temporary

___________________________________________________________________ (Name and Title of Supervisor) ___________________________________________________________________

Hrs/wk ________ Reason For Leaving:

(Your Position)

(Department)

EMPLOYER 2:

Dates of Employment:

___________________________________________________________________

(Name)

(Phone)

___________________________________________________________________

(Street)

(City)

(State)

From:

To:

Salary:

Starting:$

Ending:$

  • Full-time

  • Part-time

  • Temporary

___________________________________________________________________ Name and Title of Supervisor ___________________________________________________________________

Hrs/wk ________ Reason For Leaving:

(Your Position)

(Department)

EMPLOYER 3:

Dates of Employment:

___________________________________________________________________

(Name)

(Phone)

___________________________________________________________________

(Street)

(City)

(State)

From:

To:

Salary:

Starting:$

Ending:$

  • Full-time

  • Part-time

  • Temporary

___________________________________________________________________ (Name and Title of Supervisor) ___________________________________________________________________

Hrs/wk ________ Reason For Leaving:

(Your Position)

(Department)

EMPLOYER 4:

Dates of Employment:

___________________________________________________________________

(Name)

(Phone)

___________________________________________________________________

(Street)

(City)

(State)

From:

To:

Salary:

Starting:$

Ending:$

  • Full-time

  • Part-time

  • Temporary

___________________________________________________________________ (Name and Title of Supervisor) ___________________________________________________________________

Hrs/wk ________ Reason For Leaving:

(Your Position)

(Department)

EMPLOYER 5:

Dates of Employment:

___________________________________________________________________

(Name)

(Phone)

___________________________________________________________________

(Street)

(City)

(State)

From:

To:

Salary:

Starting:$

Ending:$

  • Full-time

  • Part-time

  • Temporary

___________________________________________________________________ (Name and Title of Supervisor) ___________________________________________________________________

Hrs/wk ________ Reason For Leaving:

(Your Position)

(Department)

2011 Maxum Petroleum, Inc.

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

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