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(850) 818-0601
Your Cost Plus 10% Grocery Store
1380 W. 15th St., Panama City, Florida 32401
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Piggly Wiggly Food For Less – Panama City
Cost Plus 10% Discount Grocery Store
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1
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5
20%
Application for Employment
Piggly Wiggly Food For Less is an equal opportunity employer. Piggly Wiggly Food For Less does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex, gender, sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service.
Name
*
First
Last
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Phone
*
Email
*
Do you want to work full time, part time, or both?
*
Full Time
Part Time
Both
Days and Hours Available
If employed, I will notify my supervisor in writing, should my availability change.
Sunday Availability:
A.M. Hours
P.M. Hours
Monday Availability:
A.M. Hours
P.M. Hours
Tuesday Availability:
A.M. Hours
P.M. Hours
Wednesday Availability:
A.M. Hours
P.M. Hours
Thursday Availability:
A.M. Hours
P.M. Hours
Friday Availability:
A.M. Hours
P.M. Hours
Job Applying For #1
Rate of Pay Expected
$_____ per _______
Job Applying For #2
Rate of Pay Expected
$_____ per _______
Have you worked for us before?
*
Yes
No
If yes, when?
List all relatives and/or close friends employed by our company:
Date Available:
*
MM slash DD slash YYYY
If hired, on what date will you be available to start work?
Prior Work Experience:
*
Do you have any prior work experience, which you feel would help you if hired by the company?
If hired, do you have reliable means of transportation?
*
Yes
No
Are you legally authorized to work in the United States?
*
Yes
No
If you are under 18, can you furnish a work permit if requested?
*
Yes
No
Work History
PRIOR WORK HISTORY (LIST IN ORDER. LAST OR PRESENT EMPLOYER FIRST.) **Please account for all periods of unemployment in the last five (5) years.
Company Name 1
*
Company Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Starting Date
*
MM slash DD slash YYYY
End Date
*
MM slash DD slash YYYY
Type of Business
*
Name of Supervisor
*
Phone
*
Work performed
*
Starting Salary
*
Ending Salary
*
Reason for leaving
*
May we contact them?
*
Yes
No
Company Name 2
Company Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Starting Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Type of Business
Name of Supervisor
Phone
Work performed
Starting Salary
Ending Salary
Reason for leaving
May we contact them?
Yes
No
Company Name 3
Company Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Starting Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Type of Business
Name of Supervisor
Phone
Work performed
Starting Salary
Ending Salary
Reason for leaving
May we contact them?
Yes
No
Company Name 4
Company Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Starting Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Type of Business
Name of Supervisor
Phone
Work performed
Starting Salary
Ending Salary
Reason for leaving
May we contact them?
Yes
No
Company Name 5
Company Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Starting Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Type of Business
Name of Supervisor
Phone
Work performed
Starting Salary
Ending Salary
Reason for leaving
May we contact them?
Yes
No
Schooling
High School
High School Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Years Attended
Graduated?
Yes
No
College / University
College / University Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Years Attended
Graduated?
Yes
No
Post Graduate
Post Graduate Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Years Attended
Graduated?
Yes
No
Business / Trade School
Business / Trade School Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Years Attended
Graduated?
Yes
No
Other
Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Years Attended
Graduated?
Yes
No
MILITARY SERVICE RECORD
Have you ever served in the armed forces?
*
Yes
No
If Yes, What Branch?
Dates of duty:
MM/DD/YEAR
From
To
Rank at Discharge:
What were your duties in the service (include special training and duty station)?
PERSONAL REFERENCES (Not related to you)
Reference 1
First
Last
Occupation
Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Phone
Reference 2
First
Last
Occupation
Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Phone
Reference 3
First
Last
Occupation
Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Phone
APPLICANT ACKNOWLEDGEMENT AND AUTHORIZATION
*PLEASE READ CAREFULLY BEFORE SIGNING* I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. No requested information has been concealed. I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery. I understand that submission of an application does not guarantee employment. I further understand that, should an offer of employment be extended by Fresh 4 Less that such employment with Fresh 4 Less is at will, for no specified duration and may be terminated by either Fresh 4 Less or myself at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, statements of Fresh 4 Less or its representatives used during the employment process is deemed a contract of employment real or implied. I understand that no representative of Fresh 4 Less except the President has the authority to enter into any agreement guaranteeing any conditions of employment or any agreement contrary to the foregoing statements and that any such agreements must be made in writing and signed by the President of Fresh 4 Less. In consideration for employment with Fresh 4 Less, if employed, I agree to conform to the rules, regulations, policies and procedures of Fresh 4 Less at all times and understand that such obedience is a condition of employment. I understand that due to the nature of Fresh 4 Less business, attendance and punctuality are considered essential requirements of every job at Fresh 4 Less and that poor attendance or tardiness will result in disciplinary action. I understand that if offered a position with Fresh 4 Less, I will be required to submit to a pre-employment, drug screening and background verifications as a condition of employment. I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these pre-employments tests and checks will result in withdrawal of any employment offer or termination of employment if already employed. I hereby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to Fresh 4 Less and/or any of its representatives, agents or vendors and I release all parties involved from any and all liability for any and all damage that may result from providing such information. I understand that this application is considered current for sixty (60) days. If I wish to be considered for employment after this period, I must fill out and submit a new application.
BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE STATEMENTS.
Acknowledgement
*
I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE STATEMENTS.
Name
*
First
Last
Date
*
MM slash DD slash YYYY
Name and number of person completing this form if other than applicant:
Name
First
Last
Phone
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