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Employment Application

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.

Personal Information
General Information
Referral Source:

If hired can you provide proof that you are of legal age?:
Are you legally eligible for employment in this country?:
Have you ever been employed with MOGAS Industries before?:
Do you know of any reason why you cannot perform the essential functions of the job for which you are applying with or without reasonable accommodation?:
Are you able to meet the attendance requirements of the position?:
Are you available to work overtime if required?:
Are you currently employed?:
Have you been convicted of a felony in the last seven (7) years?:
Have you worked or attended school under another name?:
General Information
Type of employement desired:

Can you travel if a job requires it?:

Do you have any commitments to another employer that might affect your employment with us?:

Employment History

List your last four (4) employers, assignments or volunteer activities, starting with the most recent, including military experience.

Educational Background

High School


Graduate School

Trade School

Other School


List the names and telephone numbers of three business/work references who are not related to you and ar not previous supervisors. If not applicable, list three school or personal references who are not related to you.

List professional, trade, business or civic activities and offices held. You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status.

Summarize special job-related skills and qualifications acquired from employment or other experience.

State any additional information that you feel may be helpful to us in considering your application.


I hereby certify that the foregoing statements are true and correct to the best of my knowledge and belief, and hereby grant the Company permission to verify such answers. I hereby consent to the procurement of a consumer or investigative consumer report by the Company for the purpose of verifying my prior employment, military record, education, character, general reputations, personal characteristics, criminal record or any other matter which may have bearing on my employment with the Company. I understand that upon written request to the company, I will be informed whether an investigative consumer report was requested and be given information as to the nature and scope of this investigation. I understand that any false statement on this application may be considered cause for rejection of this application, or for dismissal if such false statement is discovered subsequent to my employment. I hereby authorize an investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I understand and agree that any offer of employment I may receive is contingent upon my successful completion of the Company's pre-employment screening process, including my satisfactory completion of any post-offer, pre-employment medical examination, including drug / alcohol screening tests. I hereby consent to having the results of any such screening tests released to MOGAS Industries. I further understand that as a condition of continued employment, I may be required to submit to an alcohol or drug screening test at any time at the discretion of MOGAS Industries and I will be required to successfully pass such screening test or exam.

I authorize and request that all of my present and former employers and those individuals that I have listed as personal references may furnish information about my employment records, including a statement of the reasons for the termination of my employment, work performance, abilities, and other qualities pertinent to my qualifications for employment, hereby releasing them from any and all liability for damages which could arise from the furnishing of the requested information.

In consideration of my employment, I agree to comply with the policies, rules, regulation and procedures of the Company and understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this Company is "at will", which means that I may resign at any time and the Company may discharge me at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.