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Employment Application

4th Street Fillin Station / Employment Application

We want you! The management team at 4th Street Fillin Station is always on the lookout for outstanding individuals to add to our crew. Our environment is fast-paced and high-energy so our crew needs to be on point. If you are up for the challenge and are looking to become part of the 4th Street family, submit your application below.

Name *

First

Last

Position Applied For *

Were you referred by anyone? *

Yes
No

Name of Person Who Referred You:

First

Last

Contact Phone:

How do you know this person?

Phone Number: *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Date of Birth mm/dd//yyy *

If under the age of 18, can you provide the necessary work certificate at the time of employment? *

Yes
No

_______________________________________________________________________________________

Type of employment desired? *

Full Time
Part Time

Are you willing to work overtime? *

Yes
No

Have you previously applied with this company? *

Yes
No

If yes, when and where did you apply? *

Have you ever been employed by this company? *

Yes
No

Please provide dates of employment, location and reason for separation from employment.

If applicable, below list any other names by which you have been known which may be necessary to allow us to confirm your work and/or educational record. For example, change of name, use of an assumed name, nickname, etc.

Highest level of education: *

High School Diploma / GED
Some College
Associates
Bachelors
Grad School
Trade or Vocational

________________________________________________________________________________________

Please list your previous employers starting with the most recent:

Company Name:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Type of Business:

Dates Employed:

Your Job Title:

Job Duties:

Supervisor's Name:

First

Last

Supervisor's Phone:

May we contact?

Yes
No

Reason for Leaving:

What reason will this employer give for your employment termination?

Were you ever disciplined? If so, what for?

How much notice did you give when resigning? If none, explain.

________________________________________________________________________________________

Company Name:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Type of Business:

Dates Employed:

Your Job Title:

Job Duties:

Supervisor's Name:

First

Last

Supervisor's Phone:

May we contact?

Yes
No

Reason for Leaving:

What reason will this employer give for your employment termination?

Were you ever disciplined? If so, what for?

How much notice did you give when resigning? If none, explain.

________________________________________________________________________________________

Company Name:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Type of Business:

Dates Employed:

Your Job Title:

Job Duties:

Supervisor's Name:

First

Last

Supervisor's Phone:

May we contact?

Yes
No

Reason for Leaving:

What reason will this employer give for your employment termination?

Were you ever disciplined? If so, what for?

How much notice did you give when resigning? If none, explain.

________________________________________________________________________________________

Have you ever been terminated or asked to resign from a job? *

Yes
No

Please explain: *

Has your employment ever been terminated by mutual agreement? *

Yes
No

Please explain: *

Have you ever been given the choice to resign rather than be terminated? *

Yes
No

Please explain: *

________________________________________________________________________________________

If hired by this company, I understand that I will be required to provide genuine documentation establishing my identity and eligibility to be legally employed in the United States by this company. I also understand that this company only employs individuals who are legally eligible to work in the United States. *

I agree

By clicking SUBMIT, I certify that all of the information that I have provided on this application is true, accurate and complete. *

I agree

Phone

Open Daily at 7:30AM

Monday 7:30am - 11:00pm

Tuesday 7:30 AM - 11:00 PM

Wednesday 7:30 AM - 11:00 PM

Thursday 7:30 AM - 11:00 PM

Friday 7:30 AM - 1:00am

Saturday 7:30am - 1:00am

Sunday 7:30am - 11:00 PM

Contact us

4th Street Fillin Station
382 N. Orlando Ave.
Cocoa Beach, FL 32931
321-613-2462

Drop Us a Line

If you have general questions or comments, we’d love to hear from you. Feel free to visit our Contact Us page or email social@4thstreetfillinstation.com.

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