ERIE PETROLEUM INC.

1502 GREENGARDEN RD.

ERIE, PA. 16501

PLEASE PRINT AND SEND TO THE ABOVE ADDRESS

Preliminary Application - Part I

  Please read carefully and answer all questions.  Completion of this form will assist in the evaluation of your ability and possibility of success in the position for which you are applying.  Receipt of this application does not imply that the applicant will be employed.

  Application Date      /           /        

  Position Applying For :                                                                        

  I am available for  work :                      Full time                            Part time

  Date Available for employment:                                                            

  Shift I can Work :                                1st                                2nd                      3rd

  I can work weekends:                        Yes                                           No

  Have you ever filled out an application or been employed here before ?

                 Yes                     No     If yes, date:                                          

  Minimum Salary Requirement                                                                

  Name __________________________________________________________________________________                                                                                    LAST                                  FIRST                      MIDDLE         SOCIAL SECURITY #

  Current Address

 _________________________________________________________________________________ 

            NUMBER                                  STREET                                  CITY/STATE/ZIP

  Phone # (          )             -                        Do you have transportation?        Yes         No

  Drivers License #                                                                

  * List traffic violations                                                                                                             

  *Note:  Answer only if position requires license or  use of company vehicles.

  REFERRAL SOURCE :                  Newspaper                         Employment Agency

                                                 Personal Referral                Walk-In

                                                 Minority Agency                 Other

  Experience:

  Former Employers - (Enter last job first) 

  If  you are employed now, may we contact your present employer?

                      Yes                             No

        --------------------------------------------------------------------------------------------------------

  *This preliminary application will be considered only for employment purposes by the company for a period of 6 months from this application's date after which a new application must be filed.

  In compliance with applicable laws, qualified applicants are considered for all positions without regards to age, sex, race, color, religion, national origin, disability, marital and veteran status. 

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

  I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information  they may have, and release all parties from all liability for any damage that may result from furnishing same to you.

  I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of wages and salary, be terminated at any time without prior  notice and without cause. "

                    PLEASE PRINT AND SEND TO THE ABOVE ADDRESS

                                    Include Resume if Available