32 Stores and 8 Gas Stations to Serve You Better in Western Massachusetts
O'Connell's Convenience Plus Stores
Online Employment Application
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Name:  
Street address: Apt. or Box #:
City: State:
Zip:  
Area code: Telephone: Social security #:
E-mail address: 18 years or older?   yes   no
Ever work for Convenience Plus before?   yes   no Location:
Dates worked    From:    To:
Are you legally able to work in the USA?:   yes   no
Available hours you can work: Days and times available:
How did you hear about this job opportunity?:
How far can you travel? Do you have transportation:   yes   no
High School    Graduated?     yes   no  
College   Graduated?     yes   no Now enrolled? yes   no
Most recent job:
(If not applicable, list US military, all work experience in reverse chronological order or personal references.)
Company: Location:
Phone: Job description:
Supervisor: Salary:
Date worked  From: Last day worked:
Reason for leaving?  

Second most recent job:
Company: Location:
Phone: Job description:
Supervisor: Salary:
Date worked  From: Last day worked:
Reason for leaving?  
Third most recent job: 
Company: Location:
Phone: Job description:
Supervisor: Salary:
Date worked from: Last day worked:
Reason for leaving?  
Personal References:    
#1 #2 #3

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Have you ever been convicted of a felony? Yes   No (Answering "yes" does not constitute an automatic bar to employment.)
Within the last five years have you ever been convicted of a misdemeanor? Yes   No (Applicants may answer "no" with respect to a first conviction for drunkenness, simple assault, minor traffic violations, affray or disturbance of the peace.) (An applicant for employment with a sealed record on file with the commissioner of probation may answer "no record" with respect to any inquiry herein relative to prior arrest, criminal court appearances or conviction. In addition, any applicant for employment may answer "no record" with respect to any inquiry; herein relative to prior arrests, court appearances and adjudication's in all cases of delinquency or as a child in need of services which did not result in a complaint transferred to the superior court for criminal prosecution.)

I hereby certify that the information contained on this application is truthful complete and correct. I understand that if I am subsequently employed by O'Connell Oil Associates, Inc, ("O'Connell") and any information provided by me is found to be false, incomplete or misrepresented in any respect, I may be subject to immediate discharge.
I understand that this application does not constitute a contract. I further understand that if I am hired, my employment with O'Connell shall be "at will" and may be terminated by O'Connell or me at any time and for any reason.
I understand that no documents or statements of O'Connell shall constitute a contract of employment that in any way limits O'Connell's right to terminate employment at will. I further understand that the at-will nature of employment cannot be changed except by a formal written contract signed by the President of O"Connell.
I expressly authorize without reservation, O'Connell, its employees, representatives and agents to contact and obtain information from all references, employers, former employers, public agencies, licensing authorities and education institutions and to otherwise verify the accuracy of all information provided by me in this application, my resume or during my job interview. I hereby waive any and all rights and claims and release O'Connell and any person or entity contact by O'Connell from any liability with respect to O'Connell, its employees, representatives and agents seeking, gathering and using such information in the employment process.

I hereby certify and acknowledge that I have read, fully understand and accept the foregoing Application Statement.

Yes    Date:      

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O'Connell Oil Associates, Inc., is an equal opportunity employer. The Civil Rights Act of 1964 and State and Local Laws prohibit discrimination on the basis or race, color, religion, sex, national origin, veterans status ancestry, sexual orientation, physical or mental disability and marital status. In addition, State and Local laws prohibit discrimination on the basis of disability and the Age Discrimination in Employment Act of 1978 and some states and local laws prohibit discrimination on the basis of age with respect to individuals who are at least 40 years of age. It is our policy to comply fully with these Acts and information requested on this application will not be used for any purpose prohibited by law. Your application is active for 30 days. For consideration after that you must re-apply.

O'Connell Oil Associates

545 Merrill Road
Pittsfield, MA 01201
Phone:  413-499-4800
Toll free 1-800-464-4894
E-mail addresses

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Heating Oil Service in Western Massachusetts, Franklin, Hampden, Hampshire and Berkshire
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