Green Acres Fuel Job Application

Green Acres Fuel locations:

219 Schantz Road
Allentown, PA 18052

3850 Newburg Road
Easton, PA 18045

Employment History
(Give information about your last 3 jobs, starting with the most recent)
1st Most Recent Employer
Employer Name*
Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Employer Phone
Start Date
End Date
You position within the company*
Summarize your work/job responsibilities*
Ending Salary
Supervisor's Name*
First Last
Reason for Leaving*
2nd Most Recent Employer
Employer Name
Employer Address
Street Address Address Line 2 City State ZIP Code
Employer Phone #
You position within the company
Summarize your work/job responsibilities
Start Date
End Date
Supervisor's Name
First Last
Reason for Leaving
3rd Most Recent Employer
Employer Name
Employer Address
Street Address Address Line 2 City State ZIP Code
Employer Phone #
You position within the company
Summarize your work/job responsibilities
Start Date
End Date
Manager's Name
First Last
Reason for Leaving
Have you ever been fired or asked to resign?*
- Yes
- No
If answer to previous question is yes, please explain:*
Have you had any gaps in employment of more than 4 months duration in the past 10 years?*
- Yes
- No
If answer to previous question is yes, please explain:*

Issuing State	License Number	Class & Endorsements	Expiration Date

Date	Description of Accident	Fatalities	Injuries

Name	Title	Relationship to You	Phone#	Years Known

Green Acres Fuel

Class/Type of Equipment	Date Range Driven	Approximate Miles Driven

Date	Location	Charge	Penalty