Employment Application Start Your Next Adventure 1Applicant Information2Employment History3Education & Military4Skills & Qualifications5Referrals6Disclaimers & Resume Applicant InformationStation Location* Airport Heights Chevron Creekside Chevron Dimond Chevron Downtown Chevron Eagle River Chevron Fireweed Chevron Hillside Chevron Midtown Chevron Muldoon Chevron Palmer Chevron Southside Chevron Spenard Chevron Any Location Legal Name* First Middle Last Preferred Name Date of Birth* Phone*Alternate PhoneEmail* Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you have current family members or friends working at a Denali Express Chevron location?* Yes No If yes, please tell us their names.* Are you 21 years of age or older?*Required to sell tobacco, age restricted product. Yes No Are you legally eligible for employment in the U.S.?* Yes No Have you ever been convicted of a crime?* Yes No Are you seeking a permanent position?* Yes No How many days after being notified will you be able to report to work?*Please enter a number from 0 to 365.If necessary for the job, are you able to work overtime?* Yes No If necessary for the job, are you able to work the following shifts?* Any Day Night Swing Rotating Split Graveyard If necessary for the job, are you able to provide a valid AK driver's license?* Yes No Driver's License Type Commercial Non-Commercial Driver's License Endorsement(s) Hazardous Material Passengers Tankers Tank with Hazardous Materials School Bus Double/Triple Trailers Employment HistoryList most recent employment first. Include summer or temporary jobs. Be sure all your experience or employers related to this job are listed here, in the summary following this section or on an extra sheet of paper if necessary. No more than 10 years history recommended.Employer 1Company Name Company PhoneCompany Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor Name First Last Position Title, Duties, & SkillsSalary Start Date End Date Reason for LeavingEmployer 2Company Name Company PhoneCompany Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor Name First Last Position Title, Duties, & SkillsSalary Start Date End Date Reason for LeavingEmployer 3Company Name Company PhoneCompany Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor Name First Last Position Title, Duties, & SkillsSalary Start Date End Date Reason for LeavingOther EmploymentSummarize any other employment related to this job. EducationHigh School Name Graduated? Yes No College / University Years CompletedField of Study Degree Business / Technical School Years CompletedField of Study Degree Military ServiceAre you a veteran?* Yes No Duty / Specialized Training Skills & QualificationsOther QualificationsSpecial skills, abilities or honors that should be considered.Professional Licenses, Certifications or RegistrationsAdditional SkillsSkills such as supervision skills, other languages or information regarding the career/occupation you wish to bring to employer’s attention. Business or Professional ReferralsReferral 1Referral Name* First Last Referral Phone*Referral Email Referral Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Years Known and Occupation Referral 2Referral Name* First Last Referral Phone*Referral Email Referral Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Years Known and Occupation Information to the ApplicantAs part of our procedure for processing your employment application, your personal and employment information may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may make a written request for information derived from the checking of your references. If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the United States, have a physical examination and/or a drug test, or to sign a conflict of interest agreement and abide by its terms. By submitting this application, I acknowledge that I understand and agree to the information shown above.Equal Employment OpportunityWhile many employers are required by federal law to have an Affirmative Action Program, all employers are required to provide equal employment opportunity and may ask your national origin, race and sex for planning and reporting purposes only. This information is optional and failure to provide it will have no affect on your application for employment. Developed at employer request by the Alaska Department of Labor & Workforce Development, Employment Security Division.Attach Resume (Optional)Max file size: 1MBAccepted file types: doc, docx, pdf, rtf, txt, Max. file size: 1 MB.NameThis field is for validation purposes and should be left unchanged.