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Retail Application

To apply for a position:

COMPLETE ONLINE APPLICATION BELOW

-- OR --

CLICK HERE TO PRINT APPLICATION AND BRING IT IN TO ANY OF OUR LOCATIONS

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.

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