Employment Application

Personal Information

Name(Required)

First Middle Last

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Primary Phone(Required)

Alternate Phone

Job Information

Which company are you applying for?(Required)

Holtzman Oil

Holtzman Propane

Holtzman Transport

Valley Ice

Unsure

Postion(s) Desired(Required)

If multiple, separate by commas.

Date to start(Required)

Desired Pay(Required)

Are you eligible to work in the United States?(Required)

Yes

Work availability?

(check all that apply)

Nights

Weekends

Full time

Part Time

Have you ever been employed by Holtzman?

(check all that apply)

Holtzman Oil

Holtzman Propane

Holtzman Transport

Valley Ice

Please provide dates and locations of employment

Do you have any relatives who are employed by Holtzman?

Yes

Please state relative name(s) and relationship(s)

How did you find out about this position?(Required)

Employee's name

Other source

Have you ever been convicted of a felony or misdemeanor, or pled "Nolo contendere" (i.e. no contest) to any criminal charges in the past 10 years?*(Required)

Yes

If yes, please state the nature of the offense, when, where and disposition

If you answered the above question yes, was your conviction due to a plea to a lesser charge or offense?

Yes

Please Explain

Education & Training

High School Name / Address(Required)

Do you have a High School diploma or GED?(Required)

Yes

If no diploma, highest grade completed?

Did you attend college, technical or other school?(Required)

Yes

College/School Name & Address

Area of Study

Did you earn a degree?

Yes

Major

List any other skill or honors which have a direct bearing on the job for which you are applying:

Most Recent Employer

Are you currently still employed with them?(Required)

Yes, I still work there

May we contact your current employer about this application?(Required)

Yes

Company(Required)

Type of Business(Required)

Address(Required)

Phone(Required)

Job Description(Required)

Salary(Required)

Date Started(Required)

End Date (if applicable)(Required)

Last Supervisor Name(Required)

Last Supervisor Phone(Required)

Reason for Leaving(Required)

Previous Employer

Company(Required)

Type of Business(Required)

Address(Required)

Phone(Required)

Job Description(Required)

Salary(Required)

Date Started(Required)

End Date(Required)

Last Supervisor Name(Required)

Last Supervisor Phone(Required)

Reason For Leaving(Required)

Previous Employer

Company

Type of Business

Address

Phone

Job Description

Salary

Date Started

End Date

Last Supervisor Name

Last Supervisor Phone

Reason For Leaving

Previous Employer

Company

Type of Business

Address

Phone

Job Description

Salary

Date Started

End Date

Last Supervisor Name

Last Supervisor Phone

Reason For Leaving

References

List below the names of 3 professional references whom you have known for at least one year (no relatives).

Reference #1

Name(Required)

Phone(Required)

Occupation(Required)

Company

Relationship(Required)

Reference #2

Name(Required)

Phone(Required)

Occupation(Required)

Company

Relationship(Required)

Reference #3

Name(Required)

Phone(Required)

Occupation(Required)

Company

Relationship(Required)

Driver Applicants

To be completed by all non-office applicants.

Are you applying for a driver position?(Required)

Yes

Driver License Number

State

Type

Expiration Date

Date of Birth

Endorsements

Any restrictions on your Drivers License?

Please describe

Driving Experience (Class of Equipment)

Accident Record (For past 3 years)

EQUAL EMPLOYMENT OPPORTUNITY SURVEY (Not Required)

Gender

Male

Female

Race / Ethnicity

Hispanic or Latino

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or other Pacific Islander

White

Two or More Races (all persons who identify with more than one of the above five races.)

Are you a Veteran?

Yes

If Yes, please indicate that which apply:

Gulf War

Korean Era

Vietnam Era

World War II

Disabled Veteran

Other Eligible

If other eligible

CONSENT TO DISCLOSURE OF INFORMATION

READ CAREFULLY BEFORE AGREEING

I certify that all my answers in this Employment Application are true and complete to my best knowledge, and I understand that this Application will remain active for thirty (30) days only.

I authorize the Company to investigate and verify my answers and I give the Company permission to contact schools, previous employers, references, and others in its investigation. I release both the Company and the party providing the information from any liability for this purpose. I also release the Company from any liability for providing information about my employment record to any prospective employer, government agency, or other party having a legal and proper interest.

I also authorize the Company to secure financial and credit information through a consumer reporting agency, and I understand that, upon my written request made within a reasonable time, the consumer reporting agency will provide me with additional information concerning the nature and scope of any credit report investigation. I also agree to participate in computerized interviewing, assessment testing, and any other similar Company requirements which are conditions of employment.

I understand that any false or misleading answer in this Employment Application or other pre-employment inquiry is grounds for rejection of my Application or immediate termination if I have been employed.

If employed, I will comply with all Company policies and rules found in any Company policy manual, employment handbook, or other communication from the Company. I understand the Company may change its policies and rules in the future without giving notice to me.

I understand that the Company may require drug and alcohol testing as a condition of employment, or if I am involved in a work related injury, subject to applicable federal and state laws, and I consent to any such testing.

I agree not to use or disclose outside my employment with the Company any confidential information, wages, trade secret, or proprietary information, whatever its form, obtained in connection with my employment with the Company.

I understand that employment with the Company will be TERMINABLE AT WILL, that no employment contract will be valid unless made in writing and signed by the Company's President and that my employment may be ended at any time, for any reason, by me or the Company. If employed, I further understand that my first ninety (90) days are a probationary period (which may be extended in the Company's discretion) to determine whether my continued employment is appropriate.

Resume Upload

Accepted file types: jpg, jpeg, pdf, gif, png, doc, docx, Max. file size: 10 MB.

Please attach your resume.

Check to Agree(Required)

I HAVE READ AND UNDERSTAND THE ABOVE CONSENT

Applicants Signature(Required)

Employment Application

Personal Information

Job Information

Education & Training

Most Recent Employer

Previous Employer

Previous Employer

Previous Employer

References

Driver Applicants

To be completed by all non-office applicants.

EQUAL EMPLOYMENT OPPORTUNITY SURVEY (Not Required)

CONSENT TO DISCLOSURE OF INFORMATION

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Heating Oil

Gas / Diesel

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