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Application Date

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PERSONAL INFORMATION

Name:

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Address:

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Referred by:

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Are you 18 years of age older? YesNo

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Are you employed now? YesNo

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If so may we inquire of your present employer? YesNo

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

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If so, When and which location

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AVAILABLE TO WORK

Monday

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Tuesday

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Wednesday

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Thursday

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Friday

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Saturday

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Sunday

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Any available

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FORMER EMPLOYERS

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

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GENERAL

Subjects of Special Study or Research Work

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

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Activities other than religious

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REFERENCES

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

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I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the Company.

I authorize investigation of all statements contained herein and the references listed to give you any and all information concerning my previous employment and any pertinent information they may have and I release all parties from all liability for any damage that may result from furnishing the same to you. I understand and agree that if hired my employment is "at-will", there is no definite period of employment and may, regardless of the date of payment of my wages or salary, be terminated at any time without prior notice and without cause. I also understand and agree that for the first 90 days of my employment I will be an introductory employee subject to termination without cause and without prior notice.

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Employment

PERSONAL INFORMATION

Name:

Address:

Referred by:

EMPLOYMENT DESIRED

AVAILABLE TO WORK

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Any available

FORMER EMPLOYERS

GENERAL

REFERENCES

EDUCATION

Grammar School

High School

College

Others

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