Hy-Miler Convenience, District Petroleum Products, Inc., Huron, Ohio 44839

Retail Application
You can also download a PDF version of our retail employment application to fill out and bring in to any of our locations.

Job Code (if known)

PERSONAL INFORMATION

First Name Middle Initial Last Name

Address

City State Zip/Postal Code

E-Mail Address

Telephone Have you ever worked for District Petroleum? If yes, when/where?

- - Yes No

Are you 16 years of age or over? (Proof of age or a work permit will be required.)

Yes No

What prompted you to apply at Hy-Miler today?

I know someone that works at Hy-Miler
I saw the "Now Hiring" sign
I saw a newspaper ad about Hy-Miler employment
Other:

In Case of Emergency Notify:

First Last Middle

Telephone

- -

Address

City State Zip/Postal Code

AVAILABILITY

Are you legally able to be employed in this country? (If hired, verification will be required by law)

Yes No

What type of position are you seeking?

Part TimeFull TimeSeasonalTemporary

Are you able to meet the attendance requirements of the position?

Yes No

Have you been convicted of a felony within the last 7 years?
(Conviction will not necessarily disqualify an applicant from employment)

Yes No

Hours Available

S M T W T F S
From
To

Total hours available per week:

Date available to start work: / /

SCHOOL MOST RECENTLY ATTENDED

Name Address

City State Phone

- -

Teacher or Counselor Grade Completed Grade Average

Graduated? Now Enrolled?

Yes No Yes No

Sports or activities?

MOST RECENT EMPLOYMENT

Company Address

City State Telephone

- -

Position Supervisor Dates Worked

From To

Wage Reason for leaving

Company Address

City State Telephone

- -

Position Supervisor Dates Worked

From To

Wage Reason for leaving

Do we have your permission to contact your current employer?
Yes No

If NO, please explain

By clicking "Submit Application" below, I certify that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. I authorize you to make such investigations and inquires of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquires and releasing information in connection with my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.