Jobs - Staff of Life Natural Food Market

PERSONAL INFORMATION

Name

Email Address

Confirm Email

Present Address		Phone No.
Permanent Address		Phone No.

Are you a U.S Citizen?

Referred By

Store Sign Staff Worker Craig's List

Other

Position

Date you can start

For all following questions with a yes or no, please select one, and answer fully if applicable.

Are you presently employed?

If yes, please specify

If so, may we inquire of your present employer?

Name / Phone No.

We only hire for 5 shifts per week. If there are times when you are not available, please list them.

Have you ever been employed in a (a) retail store? (b) restaurant/deli? (c) bakery?

If yes, please specify

Do you have experience in working a cash register?

If yes, please specify where, how long

If applying for the deli, have you any food service experience?

If yes, please specify

How many different jobs have you had in the past five years?

Which of your past jobs did you like the best?

Why?

Have you ever received any promotions or merit raises?

Please explain

Have you ever supervised the work of others?

Please specify

Are there any past jobs that you really did not like?

If yes, please explain

Were you ever treated unfairly in a job?

If yes, please explain

Were your ever fired from a job?

If yes, please explain

Ever been interviewed by this Company before?

If so, when

How long of a commitment can you make to working at Staff of Life?

Are you willing to work weekends and holidays?

If not, please explain

Are you willing to work odd hours, early or late, if neccessary?

If not, please explain

PHYSICAL RECORD

Do you have any physical problems that prelude you from performing any work for which you are being considered?

If yes, please specify

Have you any defects in hearing, vision, speech or back problems?

If yes, please explain

Have you ever received Worker's Compensation or Disability Income payments?

If yes, describe

In case of emergency contact:

EDUCATION

	Name and Location	Yrs. Attended	Date Grad.	Subjects Studied
High School
College
Other

Other Special Study, Research or Travel during the last 3 years:

Have you any experience in dealing with the public?

If yes, please specify

What are your special interests?

Please specify

Do you have an interest in natural foods?

Please specify

Why would you like to work here?

Summarize special skills and qualifications acquired from employment or other experience

This form has been designed to comply with the state and federal fair employment pratice laws prohibiting discrimination on the basis of an applicant's sex or minority status. Questions directly or indirectly reflecting such status have been included ONLY where needed to determine a bona fide occupational qualification.

Staff of Life does not employ tobacco users. I certify that I do not use tobacco products.


Name/Signature		Date

EMPLOYMENT EXPERIENCE (If you need additional space, please continue on the last page of the application)

Start with your present or last job. Include military service assignments and volunteer activities.
Exclude organization names which indicate race, color, religion, sex or national origin.

Employer	Telephone

Address

Job Title

Supervisor

Reason For Leaving

Dates Employed

From		To

Work Performed

Employer	Telephone

Address

Job Title

Supervisor

Reason For Leaving

Dates Employed

From		To

Work Performed

Employer	Telephone

Address

Job Title

Supervisor

Reason For Leaving

Dates Employed

From		To

Work Performed

Employer	Telephone

Address

Job Title

Supervisor

Reason For Leaving

Dates Employed

From		To

Work Performed

I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal. Further, I understand and agree that a probationary period for all employment with the Staff of Life is one hundred and eighty (180) days. During this time, the Staff of Life reserves the right to dismiss an employee without cause. This, however, does not mean that after a 6 month probationary period, the worker is not subject to the same scrutiny and evaluation.

Name/Signature

Date

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