An Affirmative Action, Equal Opportunity Employer

Online Employment Application
Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.  Please provide the information requested in the spaces below and click "Submit Application". If you would prefer to complete your application offline, simply print this form from your browser control panel and fax it to 1(866)741-0706.

Position Applied For:                                                                                Location:

                                                           

First Name:                            Last Name:     
Social Security Number:     
Address:         
City:          State:            Zip:     
Telephone:             Email Address: 

If necessary, what is the best time to reach you at the above number:  AM  PM

Are you 16 years of age or older?      Yes    No
Are you legally eligible for employment in the United States?      Yes  No
Date available for work:            Desired salary:     
Type of employment desired:        Full-Time  Part-Time  Temporary  Educational Co-Op
Are you available to work on weekends?  Yes  No
Will you work overtime if required?  Yes  No    
Can you work any shift?  Yes  No  

Have you ever plead "guilty" or "no contest" to, or been convicted of a crime?      Yes  No  
If "yes", please provide dates and details: 
Answering "Yes" to these questions does not constitute an automatic bar to employment.  Factors such as the date of the offense, seriousness and nature of the violation, rehabilitation, and position applied for will be taken into account.  

Drivers license numbers if driving is an essential job function:    State: 

Skills and Qualifications
Summarize any training, skills and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.
Educational Background (if job-related)  Please select the last grade you completed in school.

High School
 8  9  10  11  12  GED 

College                                         Post Graduate
 1  2  3  4                        Yes  No  

Please tell us what school you are currently attending (or the last school that you attended).
Please tell us about any degrees, technical certificates, or special licenses you currently hold.
Employment History
Provide the following information of your past three (3) employers, assignments or volunteer activities, starting with the most recent.
Previous Employer (1)
                   Telephone
Position/Job Duties & Responsibilities
                                Dates (From-To)
Supervisor Name
Supervisor Title   		May we contact for reference?
 Yes  No 
Reason for leaving? Hourly Rate/Salary
Previous Employer (2)
                  Telephone
Position/Job Duties & Responsibilities
                               Dates (From-To)
Supervisor Name
Supervisor Title   		May we contact for reference?
Yes  No 
Reason for leaving? Hourly Rate/Salary
Previous Employer (3)
                  Telephone
Position/Job Duties & Responsibilities
                               Dates (From-To)
Supervisor Name
Supervisor Title   		May we contact for reference?
Yes  No 
Reason for leaving? Hourly Rate/Salary
References  (List three references below, preferably business related)
Name                                 Relationship                     Firm/Company                   Telephone Number
                         
                         
            

Yocum Oil Company, Inc. is an equal opportunity employer.
The following requested information is voluntary and confidential.  It will be kept separate from your application and any subsequent personnel files.  We collect this information for the sole purpose of creating and maintaining Equal Employment Opportunity and Affirmative Action records.  We appreciate your cooperation with EEO/AA efforts.

Sex: Female  Male
Race:  
African American (Black).  All persons having origins in any of the Black African racial groups: not of Hispanic origin.
Asian or Pacific Islander.  All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent or the Pacific Islands.
Caucasian (White, not of Hispanic origin).  All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.
Hispanic.   All persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.
Native American (American Indian) or Alaskan Native.  All persons having origins in any of the original peoples of North America and who maintain identifiable tribal affiliations through membership, participation or recognition.
Other.  Please list: 

Person with a Disability:
An individual: 

       A. Who has a physical or mental impairment (condition) that materially limits one or more major   life activities; or

       B. Who has a record of such impairment; or

       C. Major life activities may include such activities as caring for oneself, performing manual tasks, walking, seeing,        hearing, speaking, sitting, standing, lifting, breathing, learning, and working.)

According to the description, are you disabled?  Yes  No

How did you first learn about this position?     

Applicant Statement
I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct. 

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer's service, whenever it is discovered.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resumé or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

I further recognize that employment is subject to: 

My undergoing a physical examination by a designated physician and meeting the medical requirements of the position offered to me. Included in that examination will be testing for alcohol and drug use. I recognize that employment is contingent upon my successful completion of such tests, further recognize and agree that, if employed, the Company may exercise its right to conduct alcohol and drug screening and searches.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by thc employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. I will sign statements dealing with the employer's policy on Conflict of Interest, Confidential Information and any other required employment forms.

Do NOT submit application until you have read the Applicant Statement (above).  By submitting this application, I certify that I have read, full understand and accept all terms of the foregoing Applicant Statement.