Employment Opportunities Employment Application Please complete the entire application. 1. Employer Information Employer: 1003 Park Street Inc. Address: 1655 County Route 25 City/State/ZIP: Canton, New York 13617 Telephone: 315-714-1003 It is the policy of 1003 Park Street Inc. 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.2. Applicant Information Applicant Full Name: Home Address: Home Address City State ZIP Number of years at this address: Daytime Phone:Evening Phone:Mobile Phone:Driver's License (State/Number): 3. Emergency ContactWho should be contacted if you are involved in an emergency?Contact Name: Relationship to you: Address: Address City State ZIP Daytime Phone:Evening Phone:4. Job Position Applied For: Full or Part Time? 5. Salary Desired: per 6. Who referred you to our company? Do you have any friends or relatives who work here? If yes, please list here: 7. Have you applied to our company previously? Yes No If yes, when? 8. Are you at least 18 years old? Yes No 9. How will you get to work? 10. Are you willing to work any shift, including nights and weekends? Yes No If no, please state any limitations: 11. If applicable, are you available to work overtime? Yes No 12. If you are offered employment, when would you be available to begin work? 13. If hired, are you able to submit proof that you are legally eligible for employment in the United States? Yes No 14. Applicant's Skills Check those skills that you have. List any other skills that may be useful for the job you are seeking. Enter the number of years of experience, and circle the number that corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.) Ability or Skill Years of Experience Rating Microsoft Office Suite (Word, Excel, etc.) 1 2 3 4 5 Accounting/Bookkeeping 1 2 3 4 5 Customer service 1 2 3 4 5 Fast Food Experience 1 2 3 4 5 Deli Experience 1 2 3 4 5 Convenient Store Experience 1 2 3 4 5 Other Skills 1 2 3 4 5 Tim Hortons Experience 1 2 3 4 5 Subway Experience 1 2 3 4 5 Restaurant Experience 1 2 3 4 5 Management Experience 1 2 3 4 5 15. Applicant Employment History List your current or most recent employment first. Please list all jobs (including self-employment and military service) that you have held, beginning with the most recent, and list and explain any gaps in employment. If additional space is needed, continue on the back page of this application.Employer Name: Supervisor Name: Address: Address City State ZIP Job Duties:Reason for Leaving: Dates of Employment (Month/Year): Employer Name: Supervisor Name: Address: Address City State ZIP Job Duties:Reason for Leaving: Dates of Employment (Month/Year): Employer Name: Supervisor Name: Address Address City State ZIP Job Duties:Reason for Leaving: Dates of Employment (Month/Year): 16. Applicant's Education and Training College/University Name and AddressDid you receive a degree? Yes No If yes, degree(s) received: High School/GED Name and AddressDid you receive a degree? Yes No Other Training (graduate, technical, vocational): Please indicate any current professional licenses or certifications that you hold: Awards, Honors, Special Achievements: 17. References List any two non-relatives who would be willing to provide a reference for you. Name: Address: Address City State ZIP Telephone:Relationship: Name: Address: Address City State ZIP Telephone:Relationship: 18. Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:Certification I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for the rejection of my application or, if employment commences, immediate termination. I authorize 1003 Park Street Inc. to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education. If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Immediate Hiring Supervisor, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of 1003 Park Street Inc., except in a specific written contract of employment signed on behalf of the organization by its President, has the power to alter or vary the voluntary nature of the employment relationship.Consent(Required) I HAVE CAREFULLY READ THE ABOVE CERTIFICATION, AND I UNDERSTAND AND AGREE TO ITS TERMS.(Required)Applicant SignatureDate MM slash DD slash YYYY Which location are you willing to work?Parkway Express MorristownParkway Express Travel CenterParkway Country StoreParkway Express IGAParkway Express RaymondvilleParkway Express PotsdamParkway Express CantonParkway Express MaloneParkway Express HopkintonParkway Express MorleyEmailThis field is for validation purposes and should be left unchanged. Take the completed application to the Parkway Express location where you're applying.