EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION

Please complete the entire application
Employer Information
Mason's Propane Service LLC

317 W. King St.

East Berlin, Pennsylvania 17316

Telephone: (717) 259-0624
It is the policy of Mason's Propane Service LLC to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.
PERSONAL INFORMATION
FULL NAME*

First NameLast Name
DATE*

MonthDayYear
Date
ADDRESS*

Street Address

Street Address Line 2

CityState

Zip Code
E-MAIL*
example@example.com
PHONE*
SOCIAL SECURITY NUMBER (SSN)*
###/##/####
DATE AVAILABLE*

MonthDayYear
Date
DESIRED PAY*
HOUR or SALARY*

HOURSALARY
POSITION APPLIED FOR*
EMPLOYMENT DESIRED (Check any that apply)*

FULL-TIMEPART-TIMESEASONAL
HOW DID YOU FIND OUT ABOUT THIS JOB? *
EMPLOYMENT ELIGIBILITY
ARE YOU LEGALLY ELIGIBLE TO WORK IN THE U.S?*

YESNO
HAVE YOU EVER WORKED FOR THIS EMPLOYER?*

YESNO
IF YES, WRITE THE START AND END DATES: *
ARE YOU AT LEAST 18 YEARS OLD*

YesNo
*IF NOT, CAN YOU PROVIDE A VAILD WORK PERMIT, HIGH SCHOOL DIPLOMA, OR EQUIVALENT?*
DO ANY OF YOUR RELATIVES WORK FOR THIS COMPANY?*

YESNO
IF YES, WHO?*
HAVE YOU EVER BEEN CONVICTED OF A FELONY?*

YesNo
IF YES, PLEASE EXPLAIN*
WHAT LANGUAGES DO YOU SPEAK, READ, WRITE?*
DO YOU HAVE ANY SPECIAL SKILLS, TRAINING, OR EXPERENCE WHICH MAY HELP YOU QUALIFY FOR THIS JOB?*

YESNO
IF YES, PLEASE EXPLAIN*
DO YOU HAVE A RELIABLE MEANS OF TRANSPORTATION TO GET TO WORK?*

YESNO
Applicant's Education and Training
HIGH SCHOOL:*
HIGH SCHOOL ADDRESS*

Street Address

Street Address Line 2

CityState

Zip Code
START DATE*

MonthDayYear
Date
END DATE*

MonthDayYear
Date
GRADUATE?*

YESNO
DIPLOMA*
Did you attend college?*

YesNo
COLLEGE*
COLLEGE ADDRESS*

Street Address

Street Address Line 2

CityState

Zip Code
START DATE*

MonthDayYear
Date
END DATE*

MonthDayYear
Date
GRADUATE?*

YESNO
DEGREE*
DO YOU HAVE AN OTHER/DEGREE/CERTIFICATION TO ENTER?*

YESNO
OTHER*
ADDRESS*

Street Address

Street Address Line 2

CityState

Zip Code
START DATE*

MonthDayYear
Date
END DATE*

MonthDayYear
Date
DEGREE/CERTIFICATION*
DO YOU HAVE AN OTHER/DEGREE/CERTIFICATION TO ENTER?*

YESNO
OTHER*
ADDRESS*

Street Address

Street Address Line 2

CityState

Zip Code
START DATE*

MonthDayYear
Date
END DATE*

MonthDayYear
Date
DEGREE/CERTIFICATION*
PREVIOUS EMPLOYMENT
DO YOU HAVE PREVIOUS EMPLOYMENT?*

YesNo
EMPLOYER 1*
Company / Individual
E-MAIL*
example@example.com
PHONE*
ADDRESS*

Street Address

Street Address Line 2

CityState

Zip Code
STARTING PAY*
HOUR or SALARY*

HOURSALARY
ENDING PAY*
HOUR or SALARY*

HOURSALARY
JOB TITLE*
RESPONSIBILITIES*
START DATE*

MonthDayYear
Date
END DATE (Leave blank if still employed)*

MonthDayYear
Date
REASON FOR LEAVING*
DO YOU HAVE ANOTHER EMPLOYER TO LIST?*

YesNo
EMPLOYER 2*
Company / Individual
E-MAIL*
example@example.com
PHONE*
ADDRESS*

Street Address

Street Address Line 2

CityState

Zip Code
STARTING PAY*
HOUR or SALARY*

HOURSALARY
ENDING PAY*
HOUR or SALARY*

HOURSALARY
JOB TITLE*
RESPONSIBILITIES*
START DATE*

MonthDayYear
Date
END DATE (Leave blank if still employed)*

MonthDayYear
Date
REASON FOR LEAVING*
DO YOU HAVE ANOTHER EMPLOYER TO LIST?*

YesNo
EMPLOYER 3*
Company / Individual
E-MAIL*
example@example.com
PHONE*
ADDRESS*

Street Address

Street Address Line 2

CityState

Zip Code
STARTING PAY*
HOUR or SALARY*

HOURSALARY
ENDING PAY*
HOUR or SALARY*

HOURSALARY
JOB TITLE*
RESPONSIBILITIES*
START DATE*

MonthDayYear
Date
END DATE (Leave blank if still employed)*

MonthDayYear
Date
REASON FOR LEAVING*
REFERENCES

(PROFESSIONAL ONLY)
ARE YOU ABLE TO PROVIDE REFERENCES?*

YESNO
FULL NAME:*

First NameLast Name
RELATIONSHIP*
COMPANY*
TITLE*
E-MAIL*
example@example.com
PHONE*
ARE YOU ABLE TO PROVIDE ANOTHER REFERENCE?*

YESNO
FULL NAME:*

First NameLast Name
RELATIONSHIP*
COMPANY*
TITLE*
E-MAIL*
example@example.com
PHONE*
ARE YOU ABLE TO PROVIDE ANOTHER REFERENCE?*

YESNO
FULL NAME:*

First NameLast Name
RELATIONSHIP*
COMPANY*
TITLE*
E-MAIL*
example@example.com
PHONE*
MILITARY SERVICE
ARE YOU A VETERAN?*

YESNOI AM STILL SERVING
BRANCH*
RANK AT DISCHARGE: *
START DATE*

MonthDayYear
Date
END DATE*

MonthDayYear
Date
TYPE OF DISCHARGE*
IF NOT HONORABLE, PLEASE EXPLAIN:*
BACKGROUND CHECK CONSENT
IF ASKED, ARE YOU WILLING TO CONSENT TO A BACKGROUND CHECK?*

YESNO
DISCLAIMER
Applicant understands that this is an Equal Opportunity Employer and committed to excellence through diversity. In order to ensure this application is acceptable, please print or type with the application being fully completed in order for it to be considered.

Please complete each section EVEN IF you decide to attach a resume.

I, the Applicant, certify that my answers are true and honest to the best of my knowledge. If this application leads to my eventual employment, I understand that any false or misleading information in my application or interview may result in my employment being terminated.
I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS. *

Yes, I agree and understand these terms.
SIGNATURE*

Clear
DATE*

MonthDayYear
DateHourMinutesAM/PM Option
TYPE YOUR NAME*

PrefixFirst NameMiddle NameLast NameSuffix
Should be Empty:

Employer Information

PERSONAL INFORMATION

EMPLOYMENT ELIGIBILITY

Applicant's Education and Training

PREVIOUS EMPLOYMENT

REFERENCES

MILITARY SERVICE

BACKGROUND CHECK CONSENT

DISCLAIMER