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Employment Application
Please fill out our application form to be considered for employment.
Step
1
of
4
– Personal Information
25%
Personal Information
Name
(Required)
First
Last
Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
Cell Phone
(Required)
Email Address
(Required)
If you're under 18 years of age, please state your date of birth
MM slash DD slash YYYY
Are you interested in: (check all that apply)
(Required)
Full-Time
Part-Time
Date Available to start
(Required)
MM slash DD slash YYYY
Location
(Required)
Port Vincent Village Market
Diversion Market
Whitehall Grocery & Catering
Position you are applying for
(Required)
Salary Expected
(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
No
Were you ever discharged by any company?
(Required)
Yes
No
If yes, give name of company(ies)
Have you ever been convicted of a crime other than a minor traffic violation?
(Required)
Yes
No
(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.) 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
Employer #1
Employer
Position
Date Started
MM slash DD slash YYYY
Date Ended
MM slash DD slash YYYY
Starting Salary
Final Salary
Employer Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Name of Supervisor
Telephone Number of Supervisor
May We Contact?
Yes
No
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
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Name of Supervisor
Telephone Number of Supervisor
May we Contact?
Yes
No
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
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Name of Supervisor
Telephone Number of Supervisor
May we Contact?
Yes
No
If no, please explain
Reason for Leaving
PLEASE READ CAREFULLY
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in immediate dismissal. I understand, also, that I am required to abide by all rules and regulations of Village Markets. I understand and agree that if employed, the employment will be “at will.” That is, either I or Village Markets may end the employment relationship at any time, for any reason, or for no reason. I understand that receipt of this application by Village Markets does not imply employment and that this application and/or any other Village Markets documents are not contracts of employment.
(Required)
I certify by checking this box that I have read the above paragraph and that all information entered on my application is accurate.
Phone
This field is for validation purposes and should be left unchanged.