Employment Application Form
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1
2EMPLOYMENT APPLICATION
_________________
EMPLOYEE #
General Data
M
18
UST BE AT LEAST
YEARS OF AGE TO APPLY
______
Date: _________________ Location #
Last Name
First Name
Middle Name
Present Address Number
Street Name
City
State
Zip Code
Years at Address
Position Applying For:
Phone Number
Other Phone #
(
)
(
)
Type of employment desired: Check One
Are you available to work Weekends & Evenings?
Full Time [ ]
Part Time [ ]
[ ] Yes
or
[ ] No
How did you learn of this job opening?
Were did you submit application
[ ] Advertisement
[ ] Friend
[ ] Walk-in
[ ] Job Fair
[ ] San Fernando Valley
[ ] Antelope Valley
[ ] Relative
[ ] EDD
[ ] Other_______________
[ ] San Joaquin Valley
[ ] Victorville
Personal Data
Person to notify in case of an Emergency: Name
Address
Street
City
State
Zip Code
Home Telephone Number
(
)
Do you have any relatives working for the company? [
] Yes [
] No. Do you know what their position Is in the company? If yes list
Name_______________________________________Position___________________________________Location ________________________________
If “yes,” give dates From ____/____/___ To ___/___/___ Location: _______________
Have you ever worked for this Company before? [ ] Yes
[ ] No
Will you relocate if the job requires it?
[ ] Yes [ ] No
Will you travel if the job requires it?
[ ] Yes [ ] No
Are you able to perform the essential functions of the job for which you are applying, either with or without a reasonable accommodation? [ ] Yes [ ] No 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.)
Have you ever been convicted of a crime (felony or misdemeanor) OTHER THAN (1) a marijuana-related conviction that occurred more than two years ago; (2) a
conviction for which the record has been judicially ordered sealed, expunged or statutorily eradicated; (3) a misdemeanor conviction for which probation has been
successfully completed or otherwise discharged and the case has been judicially dismissed; or (4) a pretrial or post-trial diversion program? [ ]Yes [ ] No
Do you have any other experiences, training, qualifications, or skills which you feel make you especially suited for work at Vallarta Supermarkets? [ ]Yes [ ] No
If so, please explain:__________________________________________________________________________________________________________
Work Experience
*Last/Present Employer
Length of Service
Duties Performed
(Dates)
Address
Start
Leave
Telephone Number(s)
Supervisor's Name and Position
Hourly Rate/Salary
Your Job Title
Starting
Final
Reason For Leaving
May we contact now?
Yes
No (If still employed)
*Employer
Length of Service
Duties Performed
(Dates)
Address
Start
Leave
Telephone Number(s)
Supervisor's Name and Position
Hourly Rate/Salary
Your Job Title
Starting
Final
Reason For Leaving
May we contact now?
Yes
No (If still employed)
*Employer
Length of Service
Duties Performed
(Dates)
Address
Start
Leave
Telephone Number(s)
Supervisor's Name and Position
Hourly Rate/Salary
Your Job Title
Starting
Final
Reason For Leaving
May we contact now?
Yes
No (If still employed)
Vallarta Supermarkets is an Equal Opportunity Employer
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Parent category: Business