Application for Employment

First Name:
Middle Name:
Last Name:

Phone Number:
Email Address:

Age:
Under 16
16
17
18+

Are you eligible for employment in the United States?
Yes
No

Have you ever been convicted of a felony or a misdemeanor?
Yes
No

If you answered "Yes," you may explain here if you wish.
(Please note that answering "Yes" above will not necessarily disqualify an applicant from employment eligibility.)

Which departments / opportunities are you interested in?
(Check all that apply.)
Cart Attendant
Cashier
Customer Service
Janitorial
Bakery
Deli
Prepared Foods
Floral
Produce
Meat / Seafood
Dairy
Frozen Food
Stock (Grocery)
Overnight Stock
Pricing / File Maintenance
Management
No Preference

Do you have experience working in any of these departments?
(Check all that apply.)
Cart Attendant
Cashier
Customer Service
Janitorial
Bakery
Deli
Prepared Foods
Floral
Produce
Meat / Seafood
Dairy
Frozen Food
Stock (Grocery)
Overnight Stock
Pricing / File Maintenance
Management

Availability:

	Earliest Time:	Latest Time:
Sunday:
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:

Do you have any special scheduling needs?
If so, please explain below:

What type of employment are you interested in?
Part-Time
Full-Time
Either

I certify that all information provided herein is correct and complete. I understand that any misrepresentation made on this application will disqualify me from being considered for this or any employment opportunity at this store.

I also understand that if I am hired, my continued employment will remain contingent on my availability for work. I must maintain at all times at least the hours of availability as detailed above unless given explicit permission otherwise by store management.

Yes