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Retail

Retailer Application Form

First Name Required

Middle Name Required

Last Name Required

Street Address Required

City Required

Province Required

Postal Code Required

Phone Required

Email Required

Date of Birth Required

How did you learn about Parkland Fuel Retail Opportunities? Required

Describe three qualities that will make you a successful retailer Required

Do you have any experience in the past including education (college/university/trade) and/or any previous retail, administrative, supervisory or on the job training? Required

Are you a member of any business community organizations or trade groups? Please Explain: Required

Current Employer - Company Name

Current Employer - Type of Business

Current Employer - Position

Current Employer - Responsibilities

Current Employer - Dates of Employment

Previous Employer - Company Name

Previous Employer - Type of Business

Previous Employer - Position

Previous Employer - Responsibilities

Previous Employer - Dates of Employment

Previous Employer - Reason for leaving

Do you have any lawsuits pending? Required

Yes

No

Do you have any judgements/liens currently pending against you? Required

Yes

No

If Yes, please explain

Do you have any criminal convictions for which pardon has not been granted? (Be prepared to submit a Criminal Record Check) Required

Yes

No

Has any company that you have owned or been associated with, ever declared bankruptcy? Required

Yes

No

Have you ever declared personal bankruptcy? Required

Yes

No

Are you willing to relocate? Required

Yes

No

Are you willing to relocate to a rural location and start small to prove yourself? Required

Yes

No

What geographical areas are you interested in? (list 3 in order of preference)

Declaration Required

CASL Requirements Required

Please ensure you complete all fields of information before submitting your applications.

Failure to provide adequate information will delay our ability to process your application in a timely manner.

About Parkland
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