Careers - Garden Fresh Marketplace

"We are an equal opportunity employer."
This application will be kept on file for 6 months from date of application (for store to fill):

Mgr _________________________________________

Date ________________________

(NOTE: If you feel that your civil rights would be violated by answering a question on this form, please omit the answer to that question with a hypen (-).)

Date

Unit

Name

Address

Home/Cell Phone Number

Other Phone Number

Position Desired

Choose One:

Full-time Part-time Temporary

Please insert times on each day you would be available to work below.

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

How soon would you be available to work?

Are you 14 or older?

Yes No

Are you 16 or older?

Yes No

Are you 18 or older?

Yes No

U.S. ARMED FORCES HISTORY

U.S. Armed Forces Service

Yes No

Branch of Service

From - To

GENERAL INFORMATION

GENERAL: List outside interests

Have you ever been convicted of a crime?

Yes No

If yes, please give full details

IN CASE OF ACCIDENT OR EMERGENCY PLEASE NOTIFY:

EDUCATION

MIDDLE SCHOOL/JUNIOR HIGH SCHOOL

Years Completed

HIGH SCHOOL

Years Completed

Diploma

Yes No

Describe course of study

Describe special training, apprenticeship, skills, and extracurricular activities

COLLEGE / UNIVERSITY

Years Completed

Diploma

Yes No

Describe course of study

Describe special training, apprenticeship, skills, and extracurricular activities

GRADUATE / PROFESSIONAL

Years Completed

Degree

Yes No

Describe course of study

Describe special training, apprenticeship, skills, and extracurricular activities

Have you been employed by us before?

Yes No

If yes, please give dates employed

Have you ever been discharged from any position?

Yes No

If yes, please explain

Do any of your friends or relatives work here?

Yes No

If yes, please list their names

EMPLOYMENT EXPERIENCE / WORK HISTORY

Omit Military Service History – Give Present or Most Recent Position First

Information must be complete and accurate.

Start with your present or last employer. If you need more space, use an extra sheet of paper. If summer or part-time work, please indicate. If you were employed under a maiden or other name, please indicate that name by the employer.

EMPLOYMENT: May we request references from your present or past employers?

Yes No

EMPLOYMENT EXPERIENCE #1

Phone No.

Address

Type of Business

Date Hired

Date Left

Supervisor

Your Title & Duties

Starting Pay

Pay at Leaving

Reason for leaving

EMPLOYMENT EXPERIENCE #2

Phone No.

Address

Type of Business

Date Hired

Date Left

Supervisor

Your Title & Duties

Starting Pay

Pay at Leaving

Reason for leaving

EMPLOYMENT EXPERIENCE #3

Phone No.

Address

Type of Business

Date Hired

Date Left

Supervisor

Your Title & Duties

Starting Pay

Pay at Leaving

Reason for leaving

Is this a complete list of employment?

Yes No

Are we granted permission to check all information?

Yes No

If any, indicate by # any of the employers whom you do not want us to contact

We are an equal employment opportunity company. We are dedicated to a policy of non-discrimination in employment on any basis, including race, creed, age, sex, religion, national origin, height, weight, marital status, or disability.

I certify that the information contained in this application is correct to the best of my knowledge and understand that deliberate falsification of this information is grounds for dismissal in accordance with this company’s policy. I authorize the references listed above to give you lawful information concerning my previous employment. I agree to undergo a character investigation and I agree to take an honest verification test in accordance with State and Federal laws upon reasonable suspicion of any and all discrepancies involving my work. I understand that no representative of the company except the President has the authority to enter into my agreement for employment for any specified period of time, nor am I obligated to work for the company for any specified period of time. The President’s agreement must be in writing.

I understand that my electronic signature below serves as my signature

Yes

Sign

Email Address