Employment Application

Looking for an amazing career with a growing company? We are always looking for employees that enhance our organization through skills, leadership and culture. Please fill out this application.


Personal & General History

Are you 18 or older? Yes No

Are you prevented from lawfully becoming employed in the U.S. because of Visa or immigration status? Yes No

Have you either (1) been convicted by any court, including a court of military justice, of a criminal offense, or (2) been released from prison following conviction of a criminal offense? Minor traffic offenses should be excluded unless applying for a position which requires operation of a company vehicle.
Yes No

A conviction will not automatically disqualify an applicant for a particular job. The type and seriousness of the crime, the frequency of violations, the applicant's age at the time of conviction and the applicant's entire work and education history will be considered.

Have you ever worked for Empire before? Yes No

Have you been known by any other name(s) which Empire will require to verify your educational, employment and criminal records as furnished in this application? Yes No


Type of School

Name & Address

Graduated w/Degree

Years Completed

Major Subjects/Degrees

High School

Yes No


Yes No

Advanced Degree

Yes No

Business, Trade, Apprentice, Military, Other

Special Skills

Foreign Language Speak Read Write

Present & Prior Employment

Give details of your last four employers, and where necessary, list other previous positions which will account for your employment record over the past ten years. List present or last position first, and account for all lapses of time. Include details of military service where service specialties or duties are relevant to the job or position are seeking with Empire.

#1. Present or Last Position


#2. Previous Position


#3. Previous Position


#4. Previous Position

May your current employer be contacted? Yes No
May salary / employment dates be verified with HR? Yes No

Special Skills, Aptitudes & Other Qualifications

Software Experience Proficiency Years of Experience

Hardware Experience Proficiency Model / Language

Office/Clerical Experience Proficiency Applications

Professional References

Name & Title Relationship to you Years Known Phone Number

Certifications & Representations

I hereby apply for employment by Empire and certify that: The information contained in this application is true to the best of my knowledge and belief, and I understand and agree that misrepresentation, false statement or omission of fact by me in connection with the application will constitute justifiable cause for Empire not to employ me or, if employed, to terminate my employment for cause.

I understand and agree that all information furnished in this application may be verified by Empire. I hereby authorize all individuals and organizations named or referred to in this application and any law enforcement organization to give Empire all information relative to such verification and hereby release such individuals, organizations and Empire from any and all liability for any claim or damage resulting therefrom.

I understand that employment by Empire may be contingent upon my submitting to a physical examination that may include a screening for drug abuse prior to employment. If employed, I agree to submit to physical examinations from time to time during the course of my employment whenever requested by Empire and at Empire expense. I hereby authorize such doctors to furnish the results of such examinations to Empire.

I understand that, if I am employed by Empire and as conditions of my continued employment by Empire, I will be required to furnish proof of eligibility to work in the U.S. as required by the Immigration Reform and Control Act. I will be required to execute certain agreements with Empire (including employee agreements regarding inventions, information and conflicts of interest).

By checking the box, you agree to all of the above statements.

Submit Application

This application will be kept in the Empire active files for six months. If the applicant is not hired during that period, the applicant must complete and execute a new application to be reconsidered for employment.

"If I am employed by Empire, in consideration of such employment, I agree to conform to the rules and regulations established by Empire and understand that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either Empire or myself.

I understand that no director, manager or other representative of Empire, other than the president or his delegate, has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing."

Empire Petroleum is an equal opportunity employer and does not discriminate in employment practices or opportunities on the basis of race, color, religion, sex, national origin, age, disability, ancestry, medical conditions, sexual orientation or other bases covered by law.