Fillable Application For Employment Form printable pdf download

weis

Application for Employment

Weis Markets is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis

of actual or perceived age, sex, sexual orientation, race, color, creed, religion, familial status, ethnicity, national origin, alienage or citizenship,

disability, marital status, military or veteran status, or any other legally recognized protected basis under federal, state or local laws, regulations

or ordinances. Applicants with a disability may be entitled to reasonable accomodation under terms of the Americans with Disabilities Act and

certain state or local laws. A reasonable accomodation is a change in the way things are normally done which will ensure an equal employment

opportunity without imposing undue hardship on Weis Markets. Please inform a Company representative if you need assistance completing any

forms or to otherwise participate in the application process.

This application will remain active for 60 days, after 60 days, you must reapply for further consideration.

PLEASE PRINT CLEARLY

DATE ______________________

(USE PEN ONLY)

PERSONAL DATA

NAME_____________________________________________________________________________________________________

last

first

middle initial

ADDRESS__________________________________________________________________________________________________

street

city

state

zip

TELEPHONE ( ________ )___________________________ SOCIAL SECURITY NO.__________________________________

area code

number

Are you under the age of 18? YES

If yes, please state your age_____________________

Are you legally authorized to work in the United States? YES

(If hired, verification will be required consistent with federal law)

Have you ever been convicted of a felony which has not been expunged or sealed by a court? YES

NO RECORD

You should answer “no record” if a conviction has been sealed or expunged or otherwise statutorily eradicated. If you checked yes, please

explain below. If more space is required, please use seperate sheet. A criminal conviction will not necessarily be a bar to employment. To

help us evaluate your application, please describe the nature of the crime and your subsequent rehabilitation.

___________________________________________________________________________________________________________

How were you referred to us? Advertisement

Weis employee

Walked in

School

Employment Agency

State Employment Office

Other

(specify)________________________________________________

EMPLOYMENT AVAILABILITY

Position(s) applied for_______________________________________________ Date you can start____________________________

month/day/year

Wages desired? $______________per hour, or $______________per week

We are a 7-day-a-week business with emphasis on nights and weekends. Please indicate your availability below:

Full Time

Part Time

(How many hours?___________)

Days

Evenings

Nights

Weekends

Put the specific hours (From/To) you are available for work in the boxes below. (Leave the box empty if you are not available at all that day and

write “A” under any day you are “available” all that day without any scheduling restrictions.)

SUN

MON

TUE

WED

THU

FRI

SAT

From (AM/PM)

To (AM/PM)

Form #45

Revised 6-1-04

Application For Employment Form

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