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Electronic Job Application

Please read the following instructions before submitting your application:

1. Visit our Employment Opportunities page to see what positions we have currently available.  

2. Please read the corresponding application letter and position description for the position in which you are applying.

3. Please review the Attestation of Good Moral Character.

4. Fill out every box marked *Required on this page to ensure your application can be submitted (and any other boxes that are applicable).

5. After checking to ensure your contact information is correct, please click "Submit".

6. Wait to hear from us by phone. If you have not heard from us within 5 working business days, please call us at 386-362-7143.

Confirmation Signature
Confirmation Signature
Confirmation Signature
Contact Information
In order of Last, First, Middle Initial
xxx-xx-xxxx
xxx-xxx-xxxx
Country
Address Line 1 *
Address Line 2
City *
State/Province *
Postal Code *
xx years/xx months
Country
Address Line 1
City
State/Province
Postal Code
Not required if you have lived at your current address for more than a year.
xxx-xxx-xxxx
Employment Information
Applying for:
Only showing available positions
Shift Preference (Check all that apply):
Shift times vary based on position - see position description for more details.
Seeking (Check all that apply):
$xx.xx/year or $xx.xx/hour; please look to the position description for salary ranges.
Inlcude days and hours (am/pm) available
Have you applied previously?
Have you worked here previously?
Have you ever been bonded?
Have you ever been convicted of a crime other than a minor traffic violation?
Have you ever been discharged/asked to resign?
Does your present employer know of your plans to change employment?
Have you ever held a position of trust?
Such as handling money or confidential material
Such as call-outs, leave, etc.
Do you have reliable transportation?
Education Information
School name, Location, GPA, Graduation Date
Did You Graduate?
All positions (except Rest Area Attendant) require a GED or Diploma.
College Name(s), Location(s), GPA(s), Graduation Date(s)
Prior Employer Record

If you do not have any employment history information for the required fields below, you can enter "N/A".

Country
Address Line 1
City
State/Province
Postal Code
Start Month
/
Start Day
/
Start Year
-
End Month
/
End Day
/
End Year
If currently employed here, put the end date as today.
Please enter monetary amounts only.
Please enter monetary amounts only.
Country
Address Line 1
City
State/Province
Postal Code
Start Month
/
Start Day
/
Start Year
-
End Month
/
End Day
/
End Year
If currently employed here, put your expected end date or today's date.
Please enter monetary amounts only.
Please enter monetary amounts only.
Please include begin/end salary and reason for leaving.
Country
Address Line 1
City
State/Province
Postal Code
Start Month
/
Start Day
/
Start Year
-
End Month
/
End Day
/
End Year
Please enter monetary amounts only.
Please enter monetary amounts only.
Please include begin/end salary and reason for leaving
Military Record
Have you served in the Armed Forces?
Start Month
/
Start Day
/
Start Year
-
End Month
/
End Day
/
End Year
References
Name, address, occupation, phone number
Name, address, occupation, phone number
Name, address, occupation, phone number
Applications are received and employees are hired without regard to race, creed, color, sex, religion, age, national origin, marital status, physical or mental handicap, veteran's status, or citizenship status. The receipt of this application does not mean that job openings exist and does not obligate us in any way. We appreciate your interest in our organization. We are an equal opportunity employer. Qualified people with disabilities encouraged to apply. Reasonable accommodations will be made. Please let us know if you need assistance completing this application.
The facts set forth in my application for employment are true and complete. I understand that if employed, false statements on this application shall be considered sufficient cause for dismissal. You are hereby authorized to make any investigation of my personal history, financial and credit record through any investigative, credit agencies or bureaus of your choice.
In making this application for employment, I also understand that an investigative consumer report may be made whereby information is obtained through personal interviews with my neighbors, friends, or others with whom I am acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living. I understand that I have the right to make a written request within a reasonable period of time to receive additional, detained information about the nature and scope of this investigative consumer report.
I understand that employment at this organization is "at will", and includes no guarantee, contract, or promise of employment for any specific length of time. I authorize the use of any of this information in this application to verify my statements, and I authorize the past employers, doctors, and any other persons to answer all questions asked concerning my ability, character, reputation and previous employment record. I release all such persons from any liability or damages on account of having furnished such information.
No file selected
Please type your name and today's date as your electronic signature

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