PERSONAL INFORMATION

Name:

Address:

Last

First

Middle

Street

City

State

Phone No.

Referred by

Are you 18 years of age older? YesNo

EMPLOYMENT DESIRED

Position

Date you can start

Salary desired

Are you employed now? YesNo

If so may we inquire of your present employer? YesNo

Which store are you applying for? Check all that apply.
AnyNilesDes PlainesSchaumburgBridgeviewArcherDowners Grove

Have you ever worked at any Shop and Save Market? YesNo

If so, When and which location

EDUCATION

Grammar School

High School

College

Others

Name & location of school

Last year
completed

Did you
graduate?

Subjects studies
& degree(s) received

YesNo

1234

YesNo

1234

YesNo

1234

YesNo

GENERAL

Subjects of Special Study or Research Work

Job Related Skills (typing, driver's license, etc.)

Activities other than religious

FORMER EMPLOYERS

List below your last four employers, starting with the last one first.

Date
Month & Year

Name & address of employer

Salary
(upon leaving)

Position

Reason for leaving

From

To

From

To

From

To

From

To

REFERENCES

List below three persons not related to you, whom you have known at least one year.

Name

Address

Position

Years
Acquainted