Personal Information

*Full name
*Street address
*City
*State
*Zip
*Telephone number  ex(999)999-9999  
Email  
Have you ever applied at Signal Food Stores before? Yes
No
If so, when?  (ex 01/01/00)  
Do you have reliable transportation? Yes
No
Were you referred by a Signal Food Stores employee? Yes
No
If so, whom?
Desired location
*Desired starting pay ($)
Per hour
Per week
Which days of the week are you available to work? check all that apply Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
During what times are you available to work?
*Are you willing to work weekends and holidays? Yes
No
*When will you be available to begin work?  (ex 01/01/00)   
Are you at least 18 years old? Yes
No
Are you looking for full time or part time work? Full Time
Part Time
Any
Have you ever pled guilty to or been convicted of a crime other than a routine traffic violation? Yes
No
If Yes, list date and nature of guilty plea conviction in the box below.  


Skills, Experience and Special Training

Do you have experience operating a cash register? Yes
No
Can you operate a 10-key adding machine? Yes
No
 
 
Please list any special qualifications, business equipment operating abilities, training, education, skills, or experience that you feel warrant consideration by the company.



Education

Did you graduate from high school or earn a GED? Yes
No
Name and location of college, university, business or trade school
Degree Earned Yes
No
Type of Degree
Major field of study


Work Experience

May we contact your present employer? Yes
No
Name of present or last employer
Type of business
Street Address
City
State
Dates of employment to
Starting salary
Leaving salary
Were you fired? Yes
No
Job title
Name of supervisor
Job Description and Responsibilities
Explain reasons/circumstances for changing or wanting to change jobs
If we contact this employer, would you expect them to say they would rehire you for a position you last held there? Yes
No
If no, please explain
Employer's phone number  ex (999)999-9999   

Name of employer prior to job above
Type of business
Street Address
City
State
Dates of employment  ex.(01/01/00) to
Starting salary
Leaving salary
Were you fired? Yes
No
Job title
Name of supervisor
Job Description and Responsibilities
Explain reasons/circumstances for changing or wanting to change jobs
If we contact this employer, would you expect them to say they would rehire you for a position you last held there? Yes
No
If no, please explain
Employer's phone number ex (999) 999-9999  

Name of employer prior to job above
Type of business
Street Address
City
State
Dates of employment ex (01/01/00) to
Starting salary
Leaving salary
Were you fired? Yes
No
Job title
Name of supervisor
Job Description and Responsibilities
Explain reasons/circumstances for changing or wanting to change jobs
If we contact this employer, would you expect them to say they would rehire you for a position you last held there? Yes
No
If no, please explain
Employer's phone number ex(999) 999-9999
We may contact the employers listed above unless you indicate
those you do not wish us to contact here.

Comments

If you have anything else you would like to add please type them in the box below.

*Certification And Agreement

I certify that the facts set forth in this Application For Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application could lead to disciplinary action including dismissal. I understand that the Company will run a credit check on me. The Company is hereby authorized to investigate any of the facts set forth in this application.

I understand that employment at this Company is "at will," which means that either I or the Company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager or executive of the Company, other than the President, has any authority to alter the foregoing.
Yes
No


* Required
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