Employment Application

Personal Information

Name

First Last

Phone

Email(Required)

Address

Street Address Address Line 2 City State ZIP Code

How long have you lived at this address?

Are you under the age of 18?

If under 18, can you supply a work permit?(Required)

What position(s) are you applying for?

How did you find out about this job?

Are you legally eligible for employment in the U.S.?

Have you ever been found guilty of a crime?

Are you currently on parole?

Are you currently awaiting trial?

Are you currently on deferred adjudication?

If you answered yes to any of the previous 4 questions, please explain the nature and disposition of the case:(Required)

Employment Data

What kind of work are you seeking?

Full Time

Part-Time

Temporary

Please check all that apply.

Availability

Day

From

Please list the specific day and hours you would be available for work.

Please list any shifts you can not work?

Are you currently employed?

If so, who is your current employer?(Required)

When are you available to work at MyTown Marketplace?

Have you ever been employed at MyTown Marketplace?

If yes, when?(Required)

Please list any friends or relatives that work at MyTown.

Education & Experience

What is the highest level of education you've completed?

Please describe your course of study or other training or education:

Are you currently attending school?

Work History

Please list your last three employers, starting with the most recent.

May we contact the employers listed below?

Most Recent Employer Name

Start Date

End Date

Address

Street Address Address Line 2 City State ZIP Code

Phone

Job Title / Position

Starting Salary

Ending Salary

Reason For Leaving

Second Most Recent Employer Name

Start Date

End Date

Address

Street Address Address Line 2 City State ZIP Code

Phone

Job Title / Position

Starting Salary

Ending Salary

Reason For Leaving

Third Most Recent Employer Name

Start Date

End Date

Address

Street Address Address Line 2 City State ZIP Code

Phone

Job Title / Position

Starting Salary

Ending Salary

Reason For Leaving

Personal References

Reference 1

Please include at least name & phone number.

Reference 2

Please include at least name & phone number.

Reference 3

Please include at least name & phone number.

Specialized Supermarket Experience

Please describe any specific experience that would help you if you were hired at MyTown Marketplace.

Meat or Seafood Department

Produce or Bulk Food Department

Bakery Department

Deli Department

Kitchen or Restaurant

Cashier or Bagger

Grocery Department or Night Stocker

Dairy or Frozen Food Department

Voluntary Information

You are not required to complete this information in order to be considered for employment at MyTown Marketplace. This is voluntary only!

Sex

Date of Birth

Electronic Signature

I authorize this company to make an investigation of all information contained in this employment application and I release from liability all companies and corporations supplying such information. I understand any false answers, statements or implications made by me on this application or any other required documents shall be considered sufficient cause for denial of employment or discharge. I hereby agree to submit to any drug/alcohol testing required of me, whether prior to employment or if employed by this company, at anytime thereafter.

Type Name