New Applicant

DATE:

ATTENTION: Chrissy Council, Human Resources

SUBJECT: Please provide background check.

Name: ________________________________ Potential Start Date: __________

Position: ________________________ Store Number: __________________

Requesting Manager: __________________________________

ATTACHED:

1. [ ] Employee Application

2. [ ] Signed Job Description

3. [ ] Drug Policy Pages 3 & 4

4. [ ] Authorization and Release to Obtain Information

5. [ ] Two References/Employers Contacted

6. [ ] First Interview Complete

7. [ ] Second Interview Complete

COMMENTS:

1

Southeast Petro Distributors / M & R Enterprises

402 High Point Drive, Cocoa, FL 32926

Phone: 321.631.0245 ext.116 /Fax: 321.633.0467

Email: Chrissy@southeastpetro.com

Employment Application

We are an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state, or local laws.

Applicant Information

Full Name: Date: Last First M.I.

Address:

Street Address

City State ZIP Code

Phone: Email

Date Available: Desired Salary:$ Position Applied For:

Hours Available: Days Available:

Do you have relatives employed with us, if so what is their name and location? :

How did you hear about us? ___________________________

Are you over 18?

YES

NO

Are you authorized to work in the U.S.? YES

NO

Desired Hours: Full Time

Part Time

Have you ever worked for this company? YES

NO

If yes, when?

Have you ever been convicted of a crime? YES

NO

If yes, when?

If yes, explain:

Have you ever been Terminated from employment?

YES

NO If yes, when?

If yes, explain:

Education

High School: Address:

From: To: Did you graduate?YES

NO

Diploma or GED:

College: Address:

From: To: Did you graduate?YES

NO

Degree:

Other: Address:

From: To: Did you graduate?YES

NO

Degree:

2

References

Please list three professional references that can speak about your work habits, experience, and ethics.

Full Name: Relationship:

Company: Phone:

Address: Email: Full Name: Relationship:

Company: Phone:

Address: Email: Full Name: Relationship:

Company: Phone:

Address: Email:

Previous Employment – Continued on Page 4

Company: Phone:

Address: Supervisor:

Job Title: Starting Salary:$ Ending Salary: $

Responsibilities:

From: To: Reason for Leaving:

May we contact your previous supervisor for a reference? YES

NO

Company: Phone:

Address: Supervisor:

Job Title: Starting Salary:$ Ending Salary: $

Responsibilities:

From: To: Reason for Leaving:

May we contact your previous supervisor for a reference? YES

NO

Company: Phone:

Address: Supervisor:

Job Title: Starting Salary:$ Ending Salary: $

Responsibilities:

From: To: Reason for Leaving:

May we contact your previous supervisor for a reference? YES

NO

Military Service

Branch/Position: From: To:

Responsibilities:

3

Additional Information Please use this space to explain employment gaps: ______________________________________________________________________________________________________

______________________________________________________________________________________________________

Please list and other skills or experience that would contribute to the position applying for:

______________________________________________________________________________________________________

______________________________________________________________________________________________________

Without using a calculator, please complete the following. (You may use scratch paper.)

1. The customer’s total is $31.40. She would like to put $20 on their credit card and pay the rest with a $20 bill. What is her change? ___________________________

2. If the total is 29.03 and the customer gives you two twenty dollar bills and 3 cents, what would their change be? ________________

3. If a customer purchases three non-tax items at $2.62 each and give you a five dollar bill, and four ones, how

much change will you give them? _____________________

4. How much is it to purchase a roll of quarters, dimes, and nickels? _______________

Hours Of Availability Please enter the hours you are available for each day. If hired, employees work variable hours and scheduled based on their employment application. If you are not available for hours listed below, it may result in a loss of hours and/or termination.

DAY MORNING/DAY EVENING/NIGHT OVERNIGHT NOT AVAILABLE

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

I authorize the Company or its agents to confirm all statements contained in this application and/or résumé as it relates to the position I am seeking and to the extent permitted by federal, state, or local law. I agree to complete any requisite authorization forms for the background investigation. I hereby release from liability the Company and its representative for seeking such information and all other persons, corporations, or organizations furnishing such information.

I understand that the Company is a drug-free workplace and that if a pre-employment (post-offer) drug and/or alcohol test is positive, the employment offer may be withdrawn. I agree to work under the conditions requiring a drug-free workplace, consistent with applicable federal, state, and local law.

If hired by this Company, I understand that I will be required to provide genuine documentation, as required on an I9 form, establishing my identity and eligibility to be legally employed in the United States by this Company.

Signature: Date:

4

Previous Employment - Continued

Company: Phone:

Address: Supervisor:

Job Title: Starting Salary:$ Ending Salary: $

Responsibilities:

From: To: Reason for Leaving:

May we contact your previous supervisor for a reference? YES

NO

Company: Phone:

Address: Supervisor:

Job Title: Starting Salary:$ Ending Salary: $

Responsibilities:

From: To: Reason for Leaving:

May we contact your previous supervisor for a reference? YES

NO

Company: Phone:

Address: Supervisor:

Job Title: Starting Salary:$ Ending Salary: $

Responsibilities:

From: To: Reason for Leaving:

May we contact your previous supervisor for a reference? YES

NO

Company: Phone:

Address: Supervisor:

Job Title: Starting Salary:$ Ending Salary: $

Responsibilities:

From: To: Reason for Leaving:

May we contact your previous supervisor for a reference? YES

NO

The information provided in this document is for informational purposes only and not for the purpose of providing legal, accounting, or tax advice. The information and services ADP provides should not be deemed a substitute for the advice of any such professional. Such information is by nature subject to revision and may not be the most current information available. ADP, the ADP logo, and In the Business of Your Success are registered trademarks of ADP, LLC. All other marks are the property of their respective owners. ADP and the ADP logo are registered trademarks of ADP, LLC. ADP – A more human resource. is a service mark of ADP, LLC. Copyright © 2015 ADP, LLC. adp.com

Work Opportunity Tax Credit Southeast Petro

Work Opportunity Tax Credit Southeast Petro participates in the Work Opportunity Tax Credit program. ADP Tax Credits administers this program on our behalf. Participation in the WOTC program takes place for our employees during the Southeast Petro recruiting process. Please help us make this opportunity a success by completing a WOTC survey. Your answers to these questions are confidential and will not affect your job with Southeast Petro in any way.

New Employee Work Opportunity Tax Credit Instructions Please visit the following website and register for the WOTC screening following the instructions below: https://adp.ehxforms.com/ehx/enterprises/employeelogin.asp?LANG=ENGLISH

1. Select “Click Here” to Self-Register on the site.

2. Complete the Self-Registration page and create your User ID, Password, and 4 digit PIN.

3. Select “Continue”.

4. Once the login page is back up use the User ID and Password you just created to login to the Employee Portal.

5. Complete the information required:

Social Security Number

Date of Birth

6. Select “Continue”.

7. Complete the Information required:

Phone Number

Address

8. Select “Continue”.

9. Answer the Yes/No questions to the best of your ability, if you are unsure of a question please ask your manager for

assistance.

10. Once all questions have been answered Yes/No select “Continue”.

11. If you answered Yes to any of the previous questions you will be asked a few more detailed questions to find out if you

qualify your new employer for a Tax Credit.

12. Please answer all questions to the best of your ability, if you are unsure of a question please ask your manager for

assistance.

13. Select “Continue” until you are taken to the Employee Portal Homepage.

14. Select “esign” under My Next Step.

15. A new page will appear allowing you to view the Tax Credit forms that have been populated with the information you

provided in the interview.

16. If all information is correct please enter your 4 digit PIN you created in the self-registration and select “Approve”.

17. If all information is not correct please select “Cancel”. On the Employee Portal Homepage select “Finish Interview”.

This will allow you to go back through the interview and change any incorrect information. Once you correct all

information please follow steps 13-17.

18. Once you approve the Tax Credit forms you will be taken back to the Employee Portal Homepage. Under My Next Step

your status will be No Action Required.

19. You may log out of the Employee Portal by selecting “Logout” in the top right hand corner of the page.

20. See your manager for any additional new hire requirements.

Customer Service Associate

Classification: Non-Exempt/Hourly Reports to: Store Manager

Date Last Updated: August 2, 2016

JOB DESCRIPTION

Fuel Station and Convenience Store Food Service or Dairy Queen

Summary/Objective The customer service associate position is responsible for maintaining customer service, generating sales, housekeeping, merchandising, signing, pricing, cash register operations (POS) and loss prevention in adherence to all company policy/store standards.

Essential Functions Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Ensure that each customer receives outstanding customer service by providing a customer friendly environment, including greeting and acknowledging every customer, maintaining outstanding standards, solid product knowledge and all other components of customer service.

Maintain an awareness of all product information, merchandise promotions, test merchandise and advertisements.

Assist in floor moves, merchandising, display maintenance and store housekeeping.

Assist in processing and replenishing merchandise; participate in receiving and monitoring floor stock; ensure re-wraps are done promptly.

Adhere to all company policies, procedures and practices, including signing, pricing, and loss prevention.

Accurately and efficiently complete all sales transactions and maintain proper cash and media accountabilities at POS registers. Receive payment by cash, credit cards, vouchers, or automatic debits.

Engage in suggestive selling and upselling.

Change and confirm fuel prices on a daily basis (gas stations only).

Count and have an accurate cash drawer at the end of your shift.

Maintain clean and orderly checkout areas at all times.

Food Service Maintain sanitation, health, and safety standards in work areas.

Clean food preparation areas, cooking surfaces, and utensils.

Verify that prepared food meets requirements for quality and quantity.

Prepare specialty foods such hamburgers, fried chicken, sandwiches, salads, fries, and specialty ice-cream products, following specific methods that usually require short preparation time.

Operate large-volume cooking equipment such as grills, deep-fat fryers, or griddles.

Read food orders or receive verbal instructions as to food required by patron, and prepare and cook food according to instructions.

Competencies Customer/Client Focus.

Communication Proficiency.

Organizational Skills.

Ethical Conduct.

Supervisory Responsibility This position has no supervisory responsibilities.

Work Environment This job operates in a convenience store environment. This role routinely uses a Point of Sale (POS) system.

Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is regularly required to talk and hear. This position is very active and requires standing, walking, bending, kneeling, stooping, crouching, crawling, and climbing all day. The employee must frequently lift and/or move items over 50 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

Position Type/Expected Hours of Work This is a part-time position. Hours vary depending on the needs of the store.

Required Education and Experience Ability to read and interpret documents such as department manual.

Apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

Must be able to use safety equipment, such as gloves.

Work in extreme temperatures (ex. Freezer, refrigerator or be in close proximity to cooking equipment for extended periods of time).

Must be able to work with minimum amount of supervision under stressful conditions.

Preferred Education and Experience

Previous retail, food service or customer service experience preferred.

EEO Statement M&R Enterprises of Brevard, Inc. and Affiliates provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics.

Other Duties Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

We are proud to be a Drug-free and Equal Employment Opportunity Employer!

Signatures

This job description has been approved by all levels of management:

Manager____________________________________________________ HR_________________________________________________________

Employee signature below constitutes employee's understanding of the requirements, essential functions and duties of the position.

Employee__________________________________ Date_____________

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DRUG-FREE WORKPLACE POLICY

M & R Enterprises and affiliated companies are committed to providing a safe work environment and to

fostering the well-being and health of its employees. That commitment is jeopardized when any

employee illegally uses drugs on the job; comes to work under the influence; possesses, distributes or

sells drugs in the workplace; or abuses alcohol on the job.

Therefore, M & R Enterprises and affiliated companies have established the following policy:

1. It is a violation of company policy for any employee to use, possess, sell, trade, offer for sale, or

offer to buy illegal drugs or otherwise engage in the illegal use of drugs on the job.

2. It is a violation of company policy for anyone to report to work under the influence of illegal

drugs or alcohol.

3. It is a violation of the company policy for anyone to use prescription drugs illegally.(However,

nothing in this policy precludes the appropriate use of legally prescribed medications.)

4. Violations of this policy are subject to disciplinary action up to and including termination.

Employee Assistance and Drug-Free Awareness

Illegal drug use and alcohol misuse have a number of adverse health and safety consequences.

Information about those consequences and sources of help for drug/alcohol problems is available from

the Human Resource department.

M & R Enterprises will assist and support employees who voluntarily seek help for such problems before

becoming subject to discipline and/or termination under this or other policies. Such employees may be

allowed to use accrued paid time off, placed on leave, referred to treatment providers and otherwise

accommodated as required by law. Such employees may be required to document that they are

successfully following prescribed treatment and to take and pass follow-up tests if they hold jobs that

are safety sensitive or that require driving or if they have violated this policy previously.

Employees should report to work fit for duty and free of any adverse effects of illegal drugs or alcohol.

This policy does not prohibit employees from the lawful use and possession of prescribed medications.

Employees must, however, consult with their doctors about the medications’ effect on their fitness for

South East Petro / M & R Enterprises 402 High Point Drive, Cocoa, FL 32926 Phone: 321.631.0245 ext.116 /Fax: 321.633.0467 Email: Chrissy@southeastpetro.com

2 | P a g e

duty and ability to work safely and promptly disclose any work restrictions to their supervisor.

Employees should not, however, disclose underlying medical conditions unless directed to do so.

Work Rules

The following work rules apply to all employees:

• Whenever employees are working, are operating any company vehicle, are present on

company premises, or are conducting related work off-site, they are prohibited from:

• Using, possessing, buying, selling, manufacturing or dispensing an illegal drug (to include

possession of drug paraphernalia).

• Being under the influence of alcohol or an illegal drug as defined in this policy.

• The presence of any detectable amount of any illegal drug or illegal controlled substance in

an employee’s body while performing company business or while in a company facility is

prohibited.

• M & R Enterprises will not allow any employee to perform their duties while taking

prescribed drugs that are adversely affecting the employee’s ability to safely and effectively

perform their job duties. Employees taking a prescribed medication must carry it in the

container labeled by a licensed pharmacist or be prepared to produce it if asked.

• Any illegal drugs or drug paraphernalia will be turned over to an appropriate law

enforcement agency and may result in criminal prosecution.

Required Testing

The company retains the right to require the following tests:

• Pre-employment: All applicants must pass a drug test before beginning work or receiving an

offer of employment. Refusal to submit to testing will result in disqualification of further

employment consideration.

• Reasonable suspicion: Employees are subject to testing based on observations by a supervisor

of apparent workplace use, possession or impairment. Human Resources must be consulted

before sending an employee for reasonable suspicion testing.

• Post-accident: Employees are subject to testing when they cause or contribute to accidents that

seriously damage a company vehicle, machinery, equipment or property and/or result in an

injury to themselves or another employee requiring off-site medical attention. In any of these

instances, the investigation and subsequent testing must take place within two (2) hours

following the accident, if not sooner.

3 | P a g e

• Follow-up: Employees who have tested positive, or otherwise violated this policy, are subject to

discipline up to and including discharge.

Consequences

Applicants who refuse to cooperate in a drug test or who test positive will not be hired.

Employees who refuse to cooperate in required tests or who use, possess, buy, sell, manufacture or

dispense an illegal drug in violation of this policy will be terminated.

The first time an employee tests positive for alcohol or illegal drug use under this policy, the result will

result in termination.

Employees will be paid for any post-employment time spent in alcohol/drug testing and may be

suspended pending the results of the drug/alcohol test. After the results of the test are received, a

date/time will be scheduled to discuss the results of the test; this meeting will include a member of

management and Human Resources. Should the results prove to be negative; the employee will receive

back pay for the times/days of suspension, if not in connection with any misconduct.

Confidentiality

Information and records relating to positive test results, drug and alcohol dependencies and legitimate

medical explanations provided to the medical review officer (MRO) shall be kept confidential to the

extent required by law and maintained in secure files separate from normal personnel files.

Inspections

M & R Enterprises reserves the right to inspect all portions of its premises for drugs, alcohol or other

contraband. All employees, contract employees and visitors may be asked to cooperate in inspections of

their persons, work areas and property that might conceal a drug, alcohol or other contraband.

Employees who possess such contraband or refuse to cooperate in such inspections are subject to

appropriate discipline up to and including discharge.

Crimes Involving Drugs

M & R Enterprises prohibits all employees from manufacturing, distributing, dispensing, possessing or

using an illegal drug in or on company premises or while conducting company business. Employees are

also prohibited from misusing legally prescribed or over-the-counter (OTC) drugs. Law enforcement

personnel shall be notified, as appropriate, when criminal activity is suspected.

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Drug and/or Alcohol Screen Consent Form

I hereby consent to submit to the testing for drugs and/or alcohol as shall be determined by Southeast

Petro, M & R Enterprises and affilated companies in the selection process of applicants for employment,

random testing, reasonable cause, or workplace accidents, as accourding to our Drug-Free Workplace

Policy, for the purpose of determining the drug and/or alcohol content thereof.

I agree that (Name of clinic or physician) Quest Diagnostic Center may collect these specimens for

these tests and may test them, if qualified, or forward them to a licensed or certified laboratory

designated by the company for analysis. I further agree to and hereby authorize the release of said test

results to the company.

I understand that my current use of illegal drugs may prohibit me from being employed at this

Company.

I further agree that a reproduced copy of this pre-employment consent and release form shall have the

same force and effect as the original.

I have carefully read the foregoing and fully understand its contents. I acknowledge that my signing of

this consent and release form is a voluntary act on my part and that I have not been coerced into

signing this document by anyone.

Applicant or Employee:

Print Name:

SS#: DOB:

Phone:

Address:

Signature: Date:

Witness:

Print Name:

Signature: Date:

AUTHORIZATION AND RELEASE TO OBTAIN INFORMATION

Under the provisions of the Fair Credit Reporting Act, 15 USC, Section 1681 et seq., the Americans with Disabilities Act

and all applicable federal, state, local laws and authorities having jurisdiction, I hereby authorize and permit M & R

Enterprises to obtain a consumer report and/or an investigative consumer report which may include, but is not limited to

the following:

1. My employment records, work experience and references.

2. Records concerning any driving, criminal history, credit history, civil record, workers’ Compensation (post-

offer only) and drug testing.

3. Verification of my academic and/or professional credentials, and information and/or copies of documents from

any military service records.

I understand that an “investigative consumer report” may include information as to my character, general reputation,

personal characteristics, and mode of living, which may be obtained by interviews with individuals with whom I am

acquainted or who may have knowledge concerning any such items of information.

I agree that a copy or facsimile of this authorization has the same effect as an original.

I hereby release and hold harmless any person, firm, or entity that discloses matters in accordance with this authorization,

as well as from liability that might otherwise result from the request for use of and/or disclosure of any or all of the

foregoing information.

I understand and acknowledge that under provision of the Fair Credit Reporting Act I may request a copy of any

consumer report from the consumer reporting agency that compiled the report, after I have provided proper identification.

I hereby authorize M & R Enterprises and its agents to obtain and prepare an investigative consumer report as set forth

above, as part of its investigation of my employment application. This authorization shall remain in effect over the course

of my employment. Reports may be ordered periodically during the course of my employment. NOTE: Except for those

states where an annual release is required, i.e. California (CALIFORNIA – Continuing consent concept is inapplicable

and a separate authorization must be requested each time a report is ordered CA Civ.Code 1786.22)

Signed: Date:

Personal Data (Please print)

Full Name:

List previous Names used including Maiden Names.

Date of Birth: Social Security:

Address:

City State Zip

Driver License Number:

Telephone Number:

CSR Interview Questions

1) Do you have any work experience not listed on your application?

2) Have you ever been convicted of a crime that is not listed here on your application?

3) What do you like about Customer Service positions?

4) Tell me about a time where you solved a particularly interesting problem.

5) What are you most excited about learning?

6) If I asked several of your co-workers about your greatest strength as a team member, what would they

tell me?

7) What kinds of impact are you most excited to make?

8) When was a time things didn’t go as planned, and how did you handle it?

9) Best Feedback a manager/supervisor gave you?

10) Tell me about a time you witnessed someone do something dishonest?

11) Why do you think you are the best person for this job?

12) Do you have any scheduled vacations or other events, you may need to take off in the next few months?

(Review their schedule of availability on the application.)

13) What questions do you have for me?

Second Interview – CSR

1. Check to make sure the math test, schedule of availability is filled out and the

employment application is complete.

2. Verify all job history, address gaps in employment, and address terminations.

3. Have you ever been terminated from a job? If so, why?

4. Why do you think this is a good position for you?

5. Explain what the position entails and ask “Is there anything I mentioned you would be

unable to do or have questions about? (If they mention disabilities that may be covered

under the ADA, you can ask, “Can you complete this task with special

accommodations?” It is okay to not know the answers and let them know that we can

and do make accommodations when we can and you will need to contact human

resources.)

6. Do you have any questions for me?