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(315) 797-22409754 River Road Marcy, NY 13403

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Clifford Fuel Co. Inc.

Serving Northern & Central New York

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About
- Region
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Careers
Cliff’s Local Market
Contact

Full Service Station Application

Application For Full Service Station

Step 1 of 6

16%

Personal Information
Name*

Enter your full name as it appears on your license.
Date*
MM slash DD slash YYYY

Enter today's date.
Email Address*
Phone Number*
Enter your phone number.
Address*
Street Address Apt/Suite/PO City State ZIP Code
Any other names under which you have previously been employed or under which school records would be located
Names of friends or relatives employed in this organization
If you are under 18 years of age, can you furnish a work permit?
- Yes
- No
Have you ever been employed by us before?*
- Yes
- No
If yes, provide dates*
Are you a citizen of the U.S. or do you have a valid work permit?*
- Yes
- No
Can you work overtime, if required?*
- Yes
- No
Can you work consistently and report to work on time?*
- Yes
- No
Have you ever had any training in the military related to the job you're applying for?*
- Yes
- No
If yes, please describe.*

Employment Desired
Location*
Hold shift down to select multiple locations
Date Available*
MM slash DD slash YYYY

The date on which you are available to start work.
Are you available to work:*
- Full Time
- Part Time
- Shift Work
- Temporary
Check all that apply
Days Available*
- Sunday
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
Check all that apply
Hours Available*

List time frames that you are available.
Can you travel if the job requires it?*
- Yes
- No
Are there travel limitations?*
- Yes
- No
If yes, what are they?*

Education
High School
Name of School*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Number of Years*
Degree
College
Name of School
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Number of Years
Degree
Trade, Business or Correspondence School
Name of School
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Number of Years
Degree
Professional organizations and/or licenses that may be job related:

References
Give name, address, and a telephone number of three references who are qualified to evaluate your capabilities and who are not related to you and are not previous employers.
Name*

Reference 1
Phone*
Reference 1
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name

Reference 2
Phone
Reference 2
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name

Reference 3
Phone
Reference 3
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employment Experience
- No Work Experience
From*
MM slash DD slash YYYY
To*
MM slash DD slash YYYY
Name of Employer*
Phone Number*
Address of Employer*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor*
Position*
Reason for Leaving*
May we contact employer?*
- Yes
- No
- No Further Work Experience
From*
MM slash DD slash YYYY
To*
MM slash DD slash YYYY
Name of Employer*
Phone Number*
Address of Employer*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor*
Position*
Reason for Leaving*
May we contact employer?*
- Yes
- No
- No Further Work Experience
From*
MM slash DD slash YYYY
To*
MM slash DD slash YYYY
Name of Employer*
Phone Number*
Address of Employer*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor*
Position*
Reason for Leaving*
May we contact employer?*
- Yes
- No

Applicant's Statement
I certify that answers given herein are true and complete to the best of my knowledge. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in withdrawal of an offer of employment, or if subsequent to employment, may result in dismissal.
I understand this employment application is not to be construed as a guarantee of employment. I further understand that, should I become employed, my employment with the organization does not constitute any form of contract, implied or expressed, and such employment may be terminated at will either by myself or my employer upon notice of one party to the other.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. You may use this authority to check references with former employers I have listed, unless otherwise Indicated, as well as the personal references listed.
Signature of Applicant*
Date*
MM slash DD slash YYYY
Captcha

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- Region
- Brands
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Dealer Support
Careers
Cliff’s Local Market
Contact

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