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* First Name:

MI:

* Last Name:

* Address:

* City:

* State:

* Zip Code:

* Phone Number:

* Email:

* Would You Work...

Part-timeFull-time

* Prefence:

* Are you legally authorized to work in the United States?

YesNo

* Illinois Applicants - Are you at least 21 years of age?

YesNoN/A

* All other applicants - Are you at least 18 years of age?

YesNo

* Have you been employed by Stop-N-Go before?

YesNo

Please enter previous Stop-N-Go employment location and dates:

* Do any of your friends or relatives work at Stop-N-Go?

YesNo

Please enter the names of your friends or relatives who work at Stop-N-Go names and the store locations:

* Position Applying For:

* Rate of Pay Expected:

* Date You Can Start:

High School:

Did you graduate High School?

YesNo

College:

Did you graduate College?

YesNo

College Degree:

Other:

Did you graduate from this school?

YesNo

Other Degree:

Name:

Phone:

Best Time to Contact:

Name:

Phone:

Best Time to Contact:

Name:

Phone:

Best Time to Contact:

Name:

Address:

City:

State:

Zip Code:

Phone Number:

Dates of Employment:

From:

To:

Salary:

Start:

Per:

Finish:

Per:

Position or Title:

Person to whom you reported:

Business Type:

Reason for Leaving:

Name:

Address:

City:

State:

Zip Code:

Phone Number:

Dates of Employment:

From:

To:

Salary:

Start:

Per:

Finish:

Per:

Position or Title:

Person to whom you reported:

Business Type:

Reason for Leaving:

Name:

Address:

City:

State:

Zip Code:

Phone Number:

Dates of Employment:

From:

To:

Salary:

Start:

Per:

Finish:

Per:

Position or Title:

Person to whom you reported:

Business Type:

Reason for Leaving:

Name:

Address:

City:

State:

Zip Code:

Phone Number:

Dates of Employment:

From:

To:

Salary:

Start:

Per:

Finish:

Per:

Position or Title:

Person to whom you reported:

Business Type:

Reason for Leaving:

Provide any additional information needed to describe your qualifications for the position for which you have applied:

Explain any gaps in employment that are two weeks long or greater:

Specify what hours on which days and nights when you may not be regularly available for work:

Rank in 1, 2, 3 order your shift preferences:

Days:

Afternoons/Evenings:

Midnights:

* I have read, understand and agree to the "Notice to Wisconsin and ALL Applicants".

YesNo

* I understand that if I am hired by Stop-N-Go and I am subsequently unable to obtain an operator's license, my employment may be terminated. Initials:

* I understand that employees are hired by the Stop-N-Go company; not by a specific store. As such, employees may be scheduled to work at different locations within reasonable proximity to each other. Initials:

* I understand that Stop-N-Go cannot make any guarantees regarding the number of hours available for work and I may be asked to work 1st, 2nd, or 3rd shift. I also understand that Stop-N-Go stores are open every day of the year and I must be available to work on weekends and holidays. Initials:

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