Step 1 of 4 - Personal Information

25%

Desired Work Location

Lakeview Grocery(Required)

Lakeview Grocery (129)

Personal Information

Date(Required)

MM slash DD slash YYYY

Name

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Home Phone(Required)

Cell Phone(Required)

Email Address(Required)

If Employed, can you verify that you are at least 18 years of age?(Required)

Yes

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

Yes

Date

MM slash DD slash YYYY

Can you work over-time?(Required)

Yes

Total hours you are available to work per week?

Have you ever been employed with Robert Fresh Market or any of its partner companies before?(Required)

Yes

If yes when and why did you leave?

Do You Have Any Relatives Who Work For Robért Fresh Market or any of its partner companies?(Required)

Yes

If yes, their names?

Location you are applying for?(Required)

Position you are applying for(Required)

Education

List

Type of School (High School, College, etc.)

School

Year in School

Graduated?

Legal

Are you a U.S. citizen or do you have a legal right & necessary documents to work in the U.S.?(Required)

Yes

Have you ever been convicted of a crime other than a minor traffic violation?(Required)

Yes

(Note: you are not obligated to discuss sealed or expunged records of conviction or arrest nor will such information be asked of you or considered in employment decisions.) A conviction will not disqualify an application from consideration for employment. The existence of a criminal record will not automatically disqualify you from the job for which you are applying.

If yes, please explain offense and final disposition

Employment History

Are you currently employed?(Required)

Yes

If so may we contact your current employer?(Required)

Yes

Please list your most recent employment first

Employer #1

Employer

Position

Date Ended

MM slash DD slash YYYY

Date Started

MM slash DD slash YYYY

Starting Salary

Final Salary

Employer Address

Street Address Address Line 2 City State ZIP Code

Name of Supervisor

Telephone Number of Supervisor

May We Contact?

Yes

If no, please explain

Reason for Leaving

Employer #2

Employer

Position

Date Started

MM slash DD slash YYYY

Date Ended

MM slash DD slash YYYY

Starting Salary

Ending Salary

Employer Address

Street Address Address Line 2 City State ZIP Code

Name of Supervisor

Telephone Number of Supervisor

May we Contact?

Yes

if no, please explain

Reason for Leaving

Employer #3

Employer

Position

Date Started

MM slash DD slash YYYY

Date Ended

MM slash DD slash YYYY

Starting Salary

Ending Salary

Employer Address

Street Address Address Line 2 City State ZIP Code

Name of Supervisor

Telephone Number of Supervisor

May we Contact?

Yes

If no, please explain

Reason for Leaving

Personal References

List

Name

Address

Phone#

Please Read Carefully

IMPORTANT: READ CAREFULLY

I authorize the investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for rejection or immediate dismissal. I understand that the use of this form does not indicate that there are positions open and does not in any way obligate the Company. If employed, I will comply with the Company’s rules and regulations. Further, I understand and agree that my employment is for no definite period of time and may, regardless of the date of payment of my wages and salary be terminated at any time, for any reason, without notice. No person other than the President of the Company may modify or amend the provisions stated herein.

I hereby authorize release of any information regarding any criminal convictions that may exist against me and ask my former employer(s) and all other persons named herein who might have information concerning me to give any information regarding my former employment or any other information they may have regarding me whether or not the same is a matter of record and I hereby release them and each of them from any liability for any damage whatsoever which I could or might claim because of such disclosure.*

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I certify by checking this box that I have read and understood the above statement.

I certify by checking this box that all statements made by me on the application are true and complete.

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Employment Application

Desired Work Location

Personal Information

Education

Legal

Employment History

Please list your most recent employment first

Employer #1

Employer #2

Employer #3

Personal References

Please Read Carefully

IMPORTANT: READ CAREFULLY

Lakeview Grocery