Price Chopper Application Form For Employment
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1
2PRICE CHOPPER
APPLICATION FOR EMPLOYMENT
We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, disability or any
other legally protected status.
NAME
_________________________________________________________________________________________________
(FIRST)
(MIDDLE)
(LAST)
PRESENT ADDRESS
__________________________________________________________________________________
NUMBER
STREET
CITY
STATE
ZIP
TELEPHONE NUMBER
SOCIAL SECURITY NUMBER
(____)__________________
_________________________
ARE YOU UNDER THE AGE OF 18? YES _______NO _________
IF HIRED, ON WHAT DATE WILL YOU BE AVAILABLE TO WORK ?____________________________
DO YOU KNOW ANYONE OR HAVE ANY RELATIVES EMPLOYED BY THIS COMPANY?
YES ____ NO____
___________________________________________________________________________________
(NAME)
(RELATIONSHIP)
(WHICH LOCATION?)
EDUCATION
NAME & LOCATION
YEARS COMPLETED DID YOU GRADUATE?
DEGREE OR COURSE OF STUDY
HIGH SCHOOL
________________________ 9 10 11 12
__________________ _____________________________
____________________
__________________ _____________________________
_____________________________
COLLEGE
________________________ 1 2 3 4 5 6
__________________ _____________________________
____________________
__________________ _____________________________
_____________________________
OTHER
____________________ __________________ __________________ _____________________________
WHAT PROMPTED YOUR APPLICATION?
AGENCY
OWN ACCORD
EMPLOYEE REFERRAL
ADVERTISING
OTHER
______________________________________________________________________________________________________________
POSITION(S) APPLYING FOR:
1._______________________________________ RATE OF PAY EXPECTED $ _______________
2._______________________________________ RATE OF PAY EXPECTED $ _______________
DO YOU WANT:
FULL-TIME_________
PART-TIME__________
SPECIFY DAYS AND HOURS YOU ARE AVAILABLE TO WORK:________________________
MONDAY _____________ TUESDAY _____________ WEDNESDAY ____________ THURSDAY _____________
FRIDAY _____________ SATURDAY _____________ SUNDAY _____________
DO NOT WRITE BELOW THIS LINE
FILE NUMBER ___________________START DATE ____________________
INTERVIEWED BY ____________________
JOB CODE ___________________RATE OF PAY ___________________
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Parent category: Business