Job Application

Retail Cashier Restaurant Crew Member Other:

What hours or shift are you available for work?

On what date can you start working if you are hired?

Do you have reliable transportation to and from work?

Yes No

Personal Information

Have you ever applied to or worked for Fast Stop Travel Centers before?

Yes No

Are you related to anyone currently employed by Fast Stop Travel Centers?

Yes No

Background Questions

If not, are you authorized to work in the United States?

Yes No

Will you consent to a mandatory controlled substance test?

Yes No

Have you ever been convicted of a criminal offense (felony or misdemeanor)?

Yes No

If yes, please state the nature of the crime(s), when and where convicted and disposition of the case:

Do you have any pending charges (misdemeanor or felony) that have not been adjudicated yet?

Yes No

Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.

Job Skills/Qualifications

Please list below the skills and qualifications you possess for the position for which you are applying:

Note: Fast Stop Travel Centers complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.

Education and Training

Military

Are you, or have you ever been a member of the Armed Services?

Yes No

What branch of the military did you enlist?

What was your military rank when discharged?

How many years did you serve in the military?

What military skills do you possess that would be an asset for this position?

Previous Employment

Employer 1:

Employer Name:

Job Title:

Supervisor Name:

Employer Address:

City, State and Zip Code:

Employer Telephone:

Dates Employed:

Reason for leaving:

Employer 2:

Employer Name:

Job Title:

Supervisor Name:

Employer Address:

City, State and Zip Code:

Employer Telephone:

Dates Employed:

Reason for leaving:

Employer 3:

Employer Name:

Job Title:

Supervisor Name:

Employer Address:

City, State and Zip Code:

Employer Telephone:

Dates Employed:

Reason for leaving:

References

Please list three professional references not related to you, with full name, address, phone number, and relationship. If you don't have three professional references, then list personal, unrelated references.

AT-WILL EMPLOYMENT

I understand that my employment with Fast Stop Travel Centers is "employment at will" and may be terminated at any time for any reason, with or without cause, and with or without notice, by you or the Fast Stop Travel Centers. I further understand that no representative of Fast Stop Travel Centers has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. I acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company's President.

Name	Location (City, State)	Year Graduated	Degree Earned
High School

College/University

Name	Address/City/State	Phone	Relationship

Fast Stop Travel Centers

Applicant Information

Employment Position

Personal Information

Background Questions

Job Skills/Qualifications

Education and Training

Military

Previous Employment

References

AT-WILL EMPLOYMENT