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Speedy's Employment Application

FIRST NAME (required)

MIDDLE NAME

LAST NAME (required)

PHONE NUMBER (required)

BIRTHDATE (required)

GENDER

AGE (required)

EMAIL ADDRESS

CURRENT ADDRESS (required)

HOW LONG?

PREVIOUS ADDRESS

HOW LONG?

SSN (required)

FOR FEDERAL, STATE AND LOCAL REGULATIONS REGARDING THE PERFORMANCE OF CERTAIN DUTIES, INCLUDING SALE OF TOBACCO AND LIQUOR, PLEASE STATE: ARE YOU 18 YEARS OF AGE OR OLDER? (required)

HAVE YOU PREVIOUSLY APPLIED FOR OR WORKED FOR SPEEDY'S? (required)

IF YES, WHEN / WHERE?

DO YOU KNOW ANYONE CURRENTLY EMPLOYED BY SPEEDY'S?

IF YES, WHO?

WHO DO WE CONTACT IN CASE OF EMERGENCY? (required)

PHONE NUMBER

WHEN CAN YOU START? (required)

Which city are you interested in working? (required)

St. Joseph, MO

Kansas City, KS

HIGH SCHOOL (required)

DATES ATTENDED (required)

GRADUATED? (required)

COLLEGE

DATES ATTENDED

GRADUATED?

MILITARY SERVICE?

BRANCH

DATES SERVED

ATHLETICS / ACTIVITIES

WHY WOULD YOU MAKE A GOOD SPEEDY'S EMPLOYEE? (required)

Please list any equipment or skills used in previous employment that may contribute to employment at Speedys

Do you have any limitations that would impair your performance of the job duty applied for. If so, please describe

Do you have reliable transportation?

What best describes the type of employment opportunity you are looking for.

Full Time

Part Time

Daytime

Evening

Overnight

Weekend

Weekday

Most Recent Employer (required)

Employer Phone Number (required)

DATES OF EMPLOYMENT (required)

POSITION (required)

LEAVING WAGE

REASON FOR LEAVING (required)

Previous Employer (required)

Phone Number (required)

DATES OF EMPLOYMENT

POSITION

LEAVING WAGE

REASON FOR LEAVING

REFERENCE 1 - NAME (required)

PHONE NUMBER (required)

OCCUPATION (required)

RELATION (required)

REFERENCE 2 - NAME

PHONE NUMBER

OCCUPATION

RELATION

REFERENCE 3 - NAME

PHONE NUMBER

OCCUPATION

RELATION

Would you be willing to submit to random drug testing? (required)

Yes

No

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THE APPLICATION. I UNDERSTAND THAT MISREPRESENTATION OR OMISSION OF FACTS REQUESTED IS CAUSE FOR DISMISSAL. FURTHER, I UNDERSTAND AND AGREE THAT MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT ANY PREVIOUS NOTICE.

DATE (required)

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Gas Cards

* * About the Speedy’s Fleet Card * *

MFG Coupons

Cigarette Offers

Smokeless Offers

Vapor Offers

Contact

Questions or Concerns?

Name

Store Location (required)

Phone Number

Question/Comment/Concern:

Email address (required)

Type the characters (required)

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Speedy’s Gas Cards

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Speedy’s Gas & Convenience

a variety of product

friendly customer service

Speedy’s Convenience Locations

Speedy's Employment Application

Cigarette Offers

Smokeless Offers

Vapor Offers

Questions or Concerns?

Speedy's | Convenience Store

Speedy’s Gas Cards

Speedy’s Gas & Convenience

a variety of product

friendly customer service

Speedy’s Convenience Locations

Speedy's Employment Application

Cigarette Offers

Camel Newport Natural American Spirit Pall Mall

Smokeless Offers

Grizzly

Vapor Offers

Vuse Revel Velo

Questions or Concerns?

Speedy's | Convenience Store