Employment Application

TA TravelCenters of America

Mt Vernon, MO

Section 1 of 60% Complete

Personal Information

First & Last Name

Last Four Digits of Your Social Security Number

Federal law prohibits discrimination in employment because of age. Are you 18 or older?

Contact Information

Phone

Business Phone

Street Address

City

State

Zipcode

Education

Enter High School Name, City, & State.

Enter High School City.

Enter High School State. Did you graduate?

Enter Vocational, College, or University School Name.

Enter Vocational, College, or University School City.

Enter Vocational, College, or University School State. Did you graduate?

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Section 2 of 630% Complete

Position Details

Can you at the time of employment, submit verification of your legal right to work in the U.S.? If driving is an essential function of the job, do you have a valid driver's license?

License Number.

Enter the State.

Are you DOT qualified?

What Job are you applying for?

Can you work any shift?

Starting wage expected?

Would you accept the position if it required you to move to another community? Are you party to any non-competition agreements with any former employers?

If yes, state particulars

I have read and/or had explained to me the job description and corresponding physical and mental requirements of the position for which I am applying.

I can perform all the essential job duties.

I can perform all essential job duties except:

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Section 3 of 640% Complete

Employment History

Please enter a minimum of 5 years employment history

Employer 1

Name of Employer

Employer Phone Number

Employed Date: From

Employed Date: To

Supervisor Name & Title

Base Salary/Hourly Rate

Average Hours Per Week

Reason for Leaving

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Section 4 of 675% Complete

Other Skills, Trades, or Training

List other Skills, Trades, and/or Work Experience that were not mentioned above.

Skills 1

Experience, Skill, Training, or Profession.

Company, School or Military.

Number of Years.

Military Service

Have you had any military service in the U.S. Armed Forces?

Branch of Service.

What principal duties did you perform while in service and for how long?

Are you enrolled in the Military Reserves? If yes, select status.

If yes, Expiration date of reserve status.

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Section 5 of 690% Complete

General Information

How were you referred to this company?

Have you ever applied to this company before? Have you ever been employed by this company or a subsidiary before?

List name of company.

Employed Date: From

Employed Date: To

Additional comments you feel are important to the consideration of your application.

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Section 6 of 695% Complete

I am applying for a position with TravelCenters of America. If I am employed, I agree that my employment with the company is at the will of the company, which means that the company has the right to discharge me for any reason or no reason with or without notice. I also understand that I may be terminated or laid off at the discretion of the company. I expressly agree and understand that this is the entire agreement between the company and myself on the subject of discharge, termination and/or layoff, and it may be changed only by an agreement in writing, signed by the President of the company. I agree to conform to the company's rules, and I also agree that I shall be subject to other conditions which the Company may adopt at its sole discretion.

I affirm that the information on this application is true and complete, and that intentional deception herein will result in disqualification or dismissal, if employed.

In connection with my application for employment, I understand that as a precondition to obtaining employment at TravelCenters of America, I must successfully complete a pre-employment test for drug and/or alcohol by testing negative through urinalysis or a similar test administered to detect the use or abuse of drugs and/or alcohol.

In connection with my application for employment, I understand that a through credit and background check may be made. I hereby authorize any educational institution, past or present employer, law enforcement agency, or any person who has knowledge of my education, work experience and/or criminal conviction record to release this information to TravelCenters of America or its agents. I hereby release all persons from liability as a result of providing true, accurate information.

I agree to the above terms and conditions

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