Careers Employment Application "*" indicates required fields Select Cities or Regions of Interest* Beebe Cabot Carlisle Cave City Clinton Conway Greenbrier Harrisburg Jonesboro Kensett Little Rock Lonoke Newark North Little Rock Perryville Paragould Quitman Rose Bud Searcy Walnut Ridge Please select the town or towns in the region you would like to apply.Position Applying For:*- Select -CashierAssistant MangerManager TraineeManagerDeli or Fast FoodMaintenanceName* First Middle Last Date of Birth:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Social Security Number:* Address* Street Address City State 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 ZIP Code Email* Enter Email Confirm Email Phone Number:*Mobile Number:*Potential Start Date:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920How Were You Referred To Us:*Are you at least 18 years or older?:*- Select -YesNoAre you over the age of 21?:*- Select -YesNoAre you currently employed?:*- Select -YesNoHave you ever worked for this company:*- Select -YesNoAre you legally allowed to work in the U.S.:*- Select -YesNoDo you have your physical Social Security Card (Not a picture, copy, or print out of the number)?*- Select -YesNoHave you had the COVID-19 vaccine?*- Select -YesNoType of employment desired:* Full Time Part Time Have you ever pleaded guilty, no contest, or been convicted of a crime:*- Select -YesNoIf yes, please give details (excludes traffic and moving violations):Have you ever pleaded guilty, no contest, or been convicted of a felony:*- Select -YesNoIf yes, please give details (excludes traffic and moving violations):EducationSchool OneSchool Name:* Subject Studied:* Years Attended:* Did you Graduate:*- Select -YesNoSchool TwoSchool Name: Subject Studied: Years Attended: Did you Graduate:- None -YesNoSchool ThreeSchool Name: Subject Studied: Years Attended: Did you Graduate:- None -YesNoSummarize Your Special Skills or Qualifications:ReferencesPlease list 3 people with whom you have known for at least 1 year that are not related to you.Reference OneName:* Phone Number:*Relationship:* Years Aquainted:* Reference TwoName: Phone Number:Relationship: Years Aquainted: Reference ThreeName: Phone Number:Relationship: Years Aquainted: Previous EmploymentPlease list previous employers starting with the most recent.Company OneCompany Name: Employment Start Date:Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Employment End Date:Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address Street Address City State 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 ZIP Code Phone Number:Supervisor Name and Title: Pay Rate Upon Leaving: Responsibilities:Reason for Leaving:May We Contact This Employer for a Reference:*- None -YesNoCompany TwoCompany Name: Employment Start Date:Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Employment End Date:Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address Street Address City State 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 ZIP Code Phone Number:Pay Rate Upon Leaving: Responsibilities:Reason for Leaving:May We Contact This Employer for a Reference:- None -YesNoCompany ThreeCompany Name: Employment Start Date:Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Employment End Date:Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address Street Address City State 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 ZIP Code Phone Number:Supervisor Name and Title: Pay Rate Upon Leaving: Responsibilities:Reason for Leaving:May We Contact This Employer for a Reference:- None -YesNoAvailabilityDesignate which days of the week and times you are available to work.Monday Hours:* Tuesday Hours:* Wednesday Hours:* Thursday Hours:* Friday Hours:* Saturday Hours:* Sunday Hours:* Application Questions1. What does customer service mean to you?*2. Do you have a bank account?*- Select -YesNo3. Do you have a means of getting to work every day you are scheduled?:- Select -YesNo4. Are you able to bend, stoop and lift at least 50lbs multiple times over an 8-10 hour shift?:*- Select -YesNo5. Can you stand on your feet for 8-10 hours withouth sitting?*- Select -YesNo6. "The customer is always right.":*- Select -YesNo7. Are you able, and willing, to clean bathrooms, empty trash cans, and maintain basic cleaning procedures during an 8-10 hour shift?:*- Select -YesNo8. What is the best way to handle an angry customer when you ask to see their ID for cigarettes?:*9. How would you be an asset to our company?*10. Can you provide a background check if asked to?11. "It's okay to get a fountain drink without paying for it while on my shift. That is one of the perks of working at a convenience store.":*- Select -TrueFalse12. If the total is $13.25 and the customer hands you $20.25. How much change with they be getting back??13. How long would you expect to work for us if you are hired?14. Your friends come in to the store you are working at and approach the register. They have miscellaneous alcohol, 5 candy bars, 3 fountain drinks, and want $30 in gas on Pump7. What is the first thing you do?:*15. How many days of work have you missed in the past year?:*- Select -0-23-56-89+16. What are your future goals?*17. Have you ever worked in a job that you hated? If so, what was that job?*18. Describe your ability to work under pressure.*19. What are your greatest strengths and weaknesses?*20. Do you know anybody that works for this company? If so, who are they and where do they work?*21. Are you related to anybody that works for this company? If so, who are they, how are you related, and where do they work?*22. What would keep you coming back as a customer?23. If the total is $5.63 and the customer gives you $10.00. How much change do they get back?I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. The signature I use below serves as a digital signature for the purposes of filling out this application.* I agree I disagree Signature*PhoneThis field is for validation purposes and should be left unchanged.