Application for Employment

Personal Information

Present Address

Permanent Address

Are You 18 Years or older?



Are You prevented from Lawfully Becoming Employed In This Country Because Of Visa or Immigration Status?



Employment Desired


Grammer School

High School


Trade Business Or Correspondence School


Exclude Organizations, the name of which indaicates the race, creed, sex, age, marital status, color or nation of origin of its members.

This form has been revised to comply with the provisions of the Americans with Disabilities Act
and the final regulations and interpretive guidance promulgated by the EEOC on July 26, 1991.

Former Employers

(List below last three employers, starting with last one first).


Give the names of three person not related to you, whom you have known at least one year.

The following statement applies in: Maryland & Massachusetts. (Fill in name of state)
It is unlawful in the state ofto require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

In Case Of Emergency Notify

“I certify that all the information submitted by me on this application is true and complete, and I understand that if any false informative, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time.
In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.I understand that no company representative, other than it's president, and then only when in waiting and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement company contrary to the foregoing."




Approved by:

This form has been designed to strictly comply with State and Federal fair employment pratice laws prohibiting employment discrimination. This Application for Employment Form is sold for general use throughout the United States. TOPS assumes no responsibility for the inclusion in said form of any questions which, when asked by the Employer of the Job Applicant, may violate State and/or Federal Law.

First Four Petroleum Group

1119 Beaumont Road, Roanoke, Virginia 24019