Personal Information

First Name*

Last Name*

Phone*

Email*

Street Address*

Apartment

City*

State, Zip*

  

 
 

Personal Questions

Question 1*

  Yes    No

Are you 18 years of age or older?

 

Question 2

  Yes    No

Have you ever worked for Daves Super Market in the past?

 

Question 3*

  Yes    No

Are you currently Employed?

 

Question 4

  Yes    No

Are you either a U.S. citizen or an Alien with unrestricted authorization to work in the United States?

 

Question 5*

  Yes    No

Have you ever been convicted of or charged with a felony or misdemeanor?

 
 

Work Amount Desired

 

Full Time  Part Time  Temporary / Seasonal

 
 

 

Position Desired

Alternate

Alternate

 
 

Availability

Available to Start

Weekday

Specific Times

 Monday

 Tuesday

 Wednesday

 Thursday

 Friday

 Saturday

 Sunday

 

Wage Desired

Wage Desired

Wage Per

 
 

Education: Schools, Colleges & Other Training (List In Order Of Completion)

High School

  

Name  Years Complete

 Graduated/Completed  Yes  No  Attending

 

College

  

Name  Years Complete

 Graduated/Completed  Yes  No  Attending

 

Other 1

  

Name  Years Complete

 Graduated/Completed  Yes  No  Attending

 
 

Employment History (List Most Recent First)

Employer 1

  

Employer

Last Position

Supervisor

Street Address

City

State  Zip

Phone

Ending Pay

Employed From To Reason For Leaving   

Duties & Responsibilities

 

Employer 2

  

Employer

Last Position

Supervisor

Street Address

City

State  Zip

Phone

Ending Pay

Employed From To Reason For Leaving   

Duties & Responsibilities

 

Employer 3

  

Employer

Last Position

Supervisor

Street Address

City

State  Zip

Phone

Ending Pay

Employed From To Reason For Leaving   

Duties & Responsibilities

 
 

Personal or Business References (List Most Recent First)

Reference 1

  

Name

Company

Position

Street Address

City

State  Zip

Phone

   

I know this person as a Supervisor    Co-Worker    Friend    Other

 

Reference 2

  

Name

Company

Position

Street Address

City

State  Zip

Phone

   

I know this person as a Supervisor    Co-Worker    Friend    Other

 

Reference 3

  

Name

Company

Position

Street Address

City

State  Zip

Phone

   

I know this person as a Supervisor    Co-Worker    Friend    Other

 
 

Special Skills & Qualifications

Describe any special skills or qualifications for this position.

 

  

 

 

 

  




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