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APPLICATION FOR EMPLOYMENT
STORE EMPLOYEES
2112 THORNTON
IDENTIFICATION
(Print) Last Name

P.O. BOX 1907

First Name

CLOVIS, NM 88102-1907

Social Security
Number

Middle Initial

Anthony

Avery

575-769-2311

Marcel Davon

Telephone

534-33-5181

817-307-2132

Current Street Address City

State

Zip Code

How long at this residence?

1st Previous Address City

State

Zip Code

How long at this residence?

City

State

Zip Code

How long at this residence?

Check one box:

Day

4008 Sarasota Springs Fort Worth, TX

2nd Previous Address

76123

6 Months

WORK PREFERENCE
I am available to work:
Full-Time

X

Part-Time

X

Evening

X

Night

RELATIVE/REHIRE DATA
Have you been employed with Allsup's before? Must Give Month and Date Left.

X

No

Yes

Do any of your relatives work for Allsup's?

X

No

Name

Relationship

Yes

EDUCATION
Name of Institution
High School

Major or Courses
Taken

Location of Institution

South Hills High School

Degree or Credit Hours

Fort Worth

College/Trade School

EMPLOYMENT HISTORY
May We
Name of Employer

Finish Line
Start Date
Job Title (Last)

Yes

5/1/13

Sales Associate

Job Title (Last)

Derrick

End Date

8/9/13

Start Pay

5.00

Reason for Leaving:

School Purposes
Final Pay

Description of Work and Responsibilities

5.00

Help Customer, Sell Product, Prevent Theft, Perform Task

EMPLOYMENT HISTORY
May We
Name of
Contact?
Employer

Start Date

Supervisor ( Name and Title)

Telephone Number

Contact?

Supervisor ( Name and Title)

Telephone Number

End Date

Start Pay

Description of Work and Responsibilities

Reason for Leaving:

Final Pay

X

EMPLOYMENT HISTORY
Name of Employer

May We
Contact?

Start Date
Job Title (Last)

Supervisor ( Name and Title)

Telephone Number

End Date

Reason for Leaving:

Start Pay

Final Pay

Description of Work and Responsibilities

PHYSICAL DUTIES OF STORE EMPLOYEES
Some of the essential functions & physical duties of Allsup's store positions are listed below. Since most Allsup's store employees will work alone on a shift, they are often required to perform some or all of these job functions while on duty. Please read this section carefully and complete the Applicaant Signature Area.
1. Move merchandise/equipment weighing up to a maximum of 60 lbs. With frequent moving of objects weighing up to 10 lbs.
Examples: Stack/unstack milk cases in 3' to 4' aisle (approximately 50 lbs.); replace and reconnect soft drink syrup containers beneath fountain drink dispensers (approximately 50 lbs.); move cases of cooking oil and antifreeze ( approximately 60 lbs.); assist customers with purchases (various weights and moving distances); emptying trash/garbage into dumpster. Outside garbage containers may require lifting up to 60 lbs.
2. Work on concrete or ceramic tile floors. Standard shifts are 8 hrs. (10 hrs. for Store Managers).
3. Receive, price and stock merchandise at various heights in designated store locations (normally requires using stooping, bending and stretching motions).
4. Clean and/or dust equipment, floors, shelves, windows, ect. Using soap, water and household cleaners.
5. Effectively communicate with customers, vendors and employees (normally requires conversational hearing and speaking).
6. Read and prepare shift reports and understand operating memos. Observe activity at the gas island via front window (approx.
60 ft. distance); and observe activity within the store via surveillance mirrors and direct observation (appropriate near/far vision).
7. Working conditions involve sudden changes in temperatures ( walk-in cooler, outdoor maintenance of store front and gas island).
Please Note:

If an accommodation is required to perform the job duties listed, please provide a brief description below:

APPLICANT CERTIFICATION
Have you been convicted of a crime, including deferred adjudication duing the past seven (7) years?

No

X

Yes

1. To assist in the evaluation of my employment qualifications, I hereby authorize Allsup's Convenience Stores, Inc. to request and receive reports, records and other information from any of former employers; and any other person, partnership, corporation, institution, credit bureau, law enforcement agency or educational institution having knowledge of my character, general reputation, credit-worthiness, prior work record, criminal background and education. I hereby release them and Allsup's Convenience Stores
Inc. from any responsibility arising of such disclosures.
2. I understand that my employment is conditioned on my ability to establish my identity and eligibility for employment in the United States.
3. I affirm the information provided on this document is true and complete to the best of my knowledge and agree that falsified or omitted information may disqualify me from further consideration for employment, and may be considered justification for dismissal if discovered at a later date.
4. I have read the Physical Duties/Essential Functions of Store Employees and can perform the job duties as described. Any accommodation required by me to perform these duties had been described in the space provided for this purpose.
APPLICANT SIGNATURE

DATE

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