A Great Place to Work

Personal Information:

First Name (required)

Last Name (required)

Your Email (required)

Your Address (required)

City (required)

State (required)

Zip Code (required)

Phone Number (required)

Social Security Number

Citizen of the U.S.?
 Yes No

Do you have a working Visa?
 Yes No

Are you over 18?
 Yes No

If not, how old are you?

Previous Employment Record

Employer Name:

Type of Business:

Address:

Start Date:

Start Duties:

Starting Earnings:

Leaving Date:

Leaving Duties:

Leaving Earnings:

Last immediate supervisor’s name and title:

Previous Employment Record

Employer Name:

Type of Business:

Address:

Start Date:

Start Duties:

Starting Earnings:

Leaving Date:

Leaving Duties:

Leaving Earnings:

Last immediate supervisor’s name and title:

Last education completed:

Additional Information

Have you ever filled out an application with our company?
 Yes No

Have you ever been employed in the past by our company?
 Yes No

If Yes, approximate dates and location?

What special skills or qualifications to you posses?

Do you have relatives employed by Foodtown?
 Yes No

Whom?

Do you seek full-time or part-time employment?
 Full Part

Did someone refer you to us?
 Yes No

If so, Whom?

Are you working more than one job?
 Yes No

Have you ever been convicted of a crime other than a traffic violation?
 Yes No

If yes, provide the State and nature of the crime? Note: No applicant will be excluded

Have you ever been discharged or asked to resign by any former employee?
 Yes No

If yes, explain in detail?

Are there any employees whom you DO NOT wish us to contact?
 Yes No

Applicant Agreement (required)
In completing and signing this application for employment, I understand that misrepresentation of facts is cause for cancellation of this application or separation from the company’s service if I am employed. I agree that the company shall not be liable in any respect if my employment is terminated because of falsity of statements, answers, or omissions made by me on this application. I understand further that information concerning my past record will be sought from my previous employers and other sources and I hereby release from all liability or damages those individuals, corporations, ore organizations, who provide such information. I understand any such information provided shall become the exclusive property of the company. After reading the above to indicate your agreement, choose Accept or decline.

 Accept Decline