Store you are applying for
Name of positions applying for Date available
Type of employment desired
Days and times you'd like to work

Name
Last First Middle Former

Address
  Street City State Zip

Phone

Are you at least 18 years of age?
(If under 18, hire is subject to verification that you are of minimum legal age and possess a valid work permit if applicable.)
 
Are you legally eligible for employment in the United States?
(Proof of citizenship or immigration status will be required upon hire)
 
Have you ever, under your name or another name,been convicted for (or pleaded guilty or solo contender to) a Felony or Misdemeanor?
(Yes answer might be relevant if job-related, but do not necessarily bar you from employment. Do not identify convictions for which the criminal record has been expunged, sealed or eradicated by the court; or, misdemeanor convictions for which any probation has been completed and the case dismissed by the court. Marijuana offenses more than 2 years old need not be listed.)
If yes, please give dates and explain:
 
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?
If no, describe the functions that cannot be performed:
(Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility test.)

EMPLOYMENT HISTORY
List your last three employers beginning with the most recent. Include Military experience.  

Current Employer May we contact them?    Phone Employed From Employed Until
Address Your job title Hourly rate/Salary
Describe what you did Reason for leaving Supervisor(Name and Title)

Previous Employer May we contact them?    Phone Employed From Employed To
Address Your job title Hourly rate/Salary
Describe what you did Reason for leaving Supervisor(Name and Title)

Previous Employer May we contact them?    Phone Employed From Employed To
Address Your job title Hourly rate/Salary
Describe what you did Reason for leaving Supervisor(Name and Title)

EDUCATION

Name and location of school Course of study Graduated? Degree

JOB-RELATED SKILLS
List any other special skills, aptitudes, experience, or professional licenses or certificates which qualify you for the position.


REFERENCES
List people we may contact who are qualified to evaluate your business capabilities (Do not include friends or relatives)

Name Phone No Relationship Years known


Submission of this form indicates that I have read and understand the followings:
 
  1. Acceptance of employment will be predicated upon the truthfulness of the written and verbal statements contained within this application and pre-employment process. I understand that should Wholesome Choice Market, Inc. find that any statement I have made is not truthful, any job offer extended to me may be withdrawn and if employed, I may be subject to dismissal.
  2. I authorize WHOLESOME CHOICE FOODS, INC. to make any inquiry deemed necessary for employment consideration, continued employment, and promotion within the organization including but not limited to relevant medical and drug testing, criminal background, workers' comp history, and motor vehicle record.
  3. I understand that this employment application is not to be construed as a guarantee of employment for any specific term. I further understand that my employment with WHOLESOME CHOICE FOODS, INC. does not constitute any form of contract, implied or expressed, and such employment will be terminable at-will either by myself or WHOLESOME CHOICE FOODS, INC. upon notice of one party to the other. My continued employment is dependent on satisfactory performance and the continued need for my services as determined by WHOLESOME CHOICE, INC.


I have read and agreed with the terms stated above.
I checked all the info entered for accuracy and truth.
I understand that after I click on submit button, my application is sent and I can not change it any more.