EMPLOYMENTAPPLICATION

Form#48 Rev.06 /08

You must complete all sections of this application using black or blue INK. It is the policy and practice of The Pantry, Inc. to provide equal employment opportunity to all qualified applicants without regard to race, color, religion, creed, gender, age, national origin, veteran status, disabilityoranyothercriteriadeemedunlawfulunderanyapplicablelawsandtoprovidereasonableaccommodationasrequiredbylaw.Please informtheHumanResourcesDepartmentifyouneedassistancecompletinganyformsortootherwiseparticipateintheapplicationprocess. PERSONAL DATA LastNa me First Middl e HomeTe leph one # ()
PresentStre etAddr ess: PresentCit y,State, Zip: Thepo sitio nyo uare appl yin gforis: Due to chil d la bor law s an d b eca use age restri cted prod u cts ar e s old i n our store s, pleas est ateif youar eun derthe age of21 ? No Y e s,indi cate date ofbirth: Howlongat your pres entad dres s? Payex pec ted? Dateyo uarea vail ablet ost artwork? Areyouwil lingt oworko verti me? No Yes

Areyou orwereyo ue verkn ownb yan yoth erna me(s)? NoY es,l istth e Are you legal ly auth orize d to work in theUnite dState s? No Yes name( s)bywh ich you areorwere know nan dwhen: (If hired, v erifica tion wil l be re quired cons iste ntwithfe deral law.) Doyouhavere lati vestha twork forthe Company? No Yes, lis tthe irna me(s), theirre lat ionship toyouand wherethe ywork: Haveyouever workedatan ybus inessun itoperated byTheP antrybefore? No If yesp lease li stthe las tfourd igi tsof y our social secur itynu mbera longwi ththe locat ionandda tesof em ploymen t. (Las tFourof SSN) (Lo cation) (Da tes) Note:ThePantryoperatesseveralbusinessunitsundervarioustradenamesincludingBigK,Depot,ETNA,ExpressStop,FastLane,FoodChief, HandyWay,Kangaroo,LilChamp,MiniMart,OnTheWay,QuickStop,SmokersExpress,Sprint,WickerMart&ZipMart,Cowboys,Petro Express,SayleOil. Havey oue verbe enc on victe dofor pled guilt yorno co nt esttoaf elon yor misd em eanor othert hana min ortraffi c offens e? No Yes, listt heda te,ci ty,st ate, charg ean dfina ldi spos ition below. Pleadingguiltyornocontestorbeingconvictedofa felonyormisdemeanorwillnotautomaticallydisqualifyyoufromemploymentconsideration.

Inthes ecti onb elow,pl eas eind icat ethe day san dho urst hatyo uarea vai labl eforwork. Thisdoesnotconstituteanagreement foraworkscheduleashoursaredeterminedbybusinessneed. Availa bilit y From: To: Thursd ay Friday Saturda y Sunda y Mond ay Tuesd ay Wedne sda y

EDUCATI ON
School College High Other Namea ndLo cati onofS cho ol CourseofSt udy No.ofYears Complet ed Didyou Gradu ate? Ye s No Ye s No Ye s No Degreeor Diplom a?

EMPLOYME NTH ISTOR Y

Listallemploymentstartingwiththemostrecentjobfirst.Attachanadditionalsheet,ifneeded.Explainfullyanygapsinyouremployment history.Besuretoaccountforallperiodsoftimeincludinganyperiodofunemployment.
From: Addres s: To: Present ormo strec ente mpl oyer: Teleph one # () StartingPa y: Yourjobtit le: FinalPa y:

Namea ndpo siti onof sup ervis or: Reason forlea vin g: From: Addres s: To: FormerE mplo yer:

Teleph one # () StartingPa y: Yourjobtit le: FinalPa y:

Namea ndpo siti onof sup ervis or: Reason forlea vin g: From: Addres s: To: FormerE mplo yer:

Teleph one # () StartingPa y: Yourjobtit le: FinalPa y:

Namea ndpo siti onof sup ervis or: Reason forlea vin g:

Maywe cont act allth eem plo yers shown ? Ye s No, listwhi chon e(s)a nde xpla in:
Haveyoueverbeen invo luntari ly term inated, askedto resign orresigned inl ieuof ter minat ion? No Yes,e xpla inbelo w:

CERTIF ICATI ON
I certify t hat the infor matio n prov ide d by me o n this appl i catio n alo ng with a ll oth er infor matio n I ha ve pro vide d is true and com plete. I und ersta nd t hat if, in the Comp an ys jud gme nt, I h ave m ade fals e or mi slea din g st atem ent s or omi ssi ons, an y offer of emp loy ment may be withdrawn or my e mplo ym en t with the Compa ny m ay be t ermin ated i mm ediat ely reg ar dles s of when a nd how dis cov ered. I und ersta nd t hat t he Co mp a ny may c onta ct p erso ns and pre viou s e mpl oyer s i dentif ie d on thi s appli catio n a nd I authori ze t hos e p erson s a nd e mpl oyer s to di sclo se any perti nent infor matio n to t he Co mpa ny. I relea se said per son s and e mplo yers fro m an y liabil ity whic h ma y result from th e iss uan ce of su ch infor mati on. I also aut h orize the Compa nyt o provi detr uthful inf ormat ion co ncern ing m ye m ploy ment with itt oa ny pros pec tive e mplo yers a ndI agr ee to hold theCom pan yhar mle ssfor provi ding su chinf ormat ion. I underst and th at if I am e mplo yed with t he Com pan y, my emplo ym ent is at-will. M y em plo yme nt ma y be di sc onti nued b y me or by t he Com pan y at an y tim e, for an y reas on, with o r without ad van ce not ice, with or without cau se. I als o a gree to abide by The P antry s p olici es, ru les and regul atio ns. I fu rther und ersta nd th at no one oth er than the CE O of the C ompa ny has the auth ority to e nter into any contra ct of e mplo ym e nt with me for a ny part icul ar term or to mak e an y cha ng e in any polic y, pro ced ure, be nefit or other ter m or c ondit ion o f em ploy ment, incl udin g the poli cy of at-will, ot her tha n in a do cum ent signe d by the Pre side nt of th e Com pan y. No pro visi on s in the em ploy me nt ap plic ation, han dboo ks, ben efit bo oklet s or other for ms of co mmu nic ation co nstit ute contr actu al a gr eeme nts betwe en T he P antry and an y e mpl oye e s hall c reate a contra ctofe mpl oy mentf orany parti culart erm. I further un derst and t hat th e Com pan y will re quire me to sub mit to a ba ckgr ound ch eck as a co nditi on of emp loy ment. I hereby provi de m y written con sent th at The Pa ntry may c ondu ct a ba ckgr ound che ck. Th e Pantr y ma y als o requ ire me to sub mit t o a drug te st a s a c ond ition of em plo yme nt. I unders tand that fill ing out thi s for m doe s n ot i ndic ate th ere is a positi on o pen and doe s n ot obl igat e The Pantry to h ire m e. I al so certify that I am not boun d b y an y restr icti ve c o vena nts inclu ding any non- com pete agree me nts.I hav eread and unders tandt hefor egoi ng. Signatur eof Applic ant:

Date

Thisapplicationwillbecomeinactiveafter60days.Ifyouwishtobeconsideredforemploymentafterthattime,youmustcompleteanew applicationforemployment.