Application For Employment

Please fill out the form below. You must complete all sections of the application. Mark n/a if sections are not applicable to you. Incomplete applications will not be considered. We are an Equal Opportunity Employer.
Last Name:
 First Name:
 Middle Name:
 Date:
Address:
 Home Phone:
City:
 State:
 Zip:
 Cell Phone:
Email Address:
 Social Security Number: (Upon Hire)
Have you ever applied at Sendik's Fine Foods, Inc. before?   Yes   No
If Yes: Month and Year
Position Applied For:
Are you at least 18 years old?   Yes   No
If under 18 years of age, please provide your date of birth 		Salary desired
Are you legally authorized to work in the United States?   Yes   No
Can you provide proof, upon request, that you are authorized to work in the United States?
Yes   No		 Will you work overtime if asked?
Yes   No
How were you referred to Sendik's Fine Foods, Inc.?
Agency   Walk-in   School   Newspaper   Website   Other		 When will you be available to begin work?

Emergency Contact:		 Name:
 Relationship:
 Phone:


References:		 Name:

Name:
 Relationship:

Relationship:
 Phone:

Phone:


Availability
To help us consider you for a job that matches your availability, please indicate the earliest and latest time you can work each day.
DAY MON TUE WED THUR FRI SAT SUN
Earliest Start Time
Latest End Time
Indicate the maximum number of hours/days you can work per week:
Indicate the number of hours/days you would prefer to work each week:

Education
School Name and Location
(City, State)		 Course of Study Years Completed Diploma or Degree Received
High School Yes   No
College Yes   No
Type: 
Graduate School Yes   No
Type: 
Other (Specify) Yes   No
Type: 


Special Training/Skills/Qualifications
List any special training, skills, licenses and/or certificates relevant to the types of employment you are seeking at this company (i.e. meat cutting, floral design/arrangement, baking, customer service, management):

Experience
In the space below, indicate the job in which you've had experience and the amount of time spent working in that area.
Shipping and Receiving:
Cash Register/Retail Floor:
Supervisory position? Yes   No How many employees did you supervise?
General Office:


Employment
List your current or most recent employer first and indicate a continuous record of employment for the last ten years or from the time you left school. Please add a supplementary sheet if additional space is required.
If you are currently employed, may we contact your employer about this application? Yes   No
Employer: Phone:
Address: Employed
(MM/YY):		 From: To:
Job title/duties: Starting rate: $ per
Ending rate: $ per
Supervisor: Reason for leaving:

Employer: Phone:
Address: Employed
(MM/YY):		 From: To:
Job title/duties: Starting rate: $ per
Ending rate: $ per
Supervisor: Reason for leaving:

Employer: Phone:
Address: Employed
(MM/YY):		 From: To:
Job title/duties: Starting rate: $ per
Ending rate: $ per
Supervisor: Reason for leaving:

Employer: Phone:
Address: Employed
(MM/YY):		 From: To:
Job title/duties: Starting rate: $ per
Ending rate: $ per
Supervisor: Reason for leaving:
Please explain any gaps in your employment history:

Background Information
Have you ever been known by any other name(s) which this company will need to verify any of the information contained in this application?
Yes   No
If yes, give name(s) and identify the related school, employer, etc.
Have you ever been convicted of a crime or pleaded no contest for any offense or violation other than minor traffic violations?
Yes   No
If yes, explain 1) nature of the crime, 2) date of conviction and 3) state in which convicted.
Do you have any pending criminal charges against you?  Yes   No
If yes, describe 1) nature of charges, 2) date issued and 3) county and state where issued.
Note: A criminal record or a pending criminal charge does not constitute an automatic bar to employment by the company and will be considered only as it relates to the job for which you are applying.


Please Read Carefully Before Submitting
Federal law requires the company to notify each applicant that we:
  • Hire only United States citizens and aliens authorized to work in United States
  • Will require all new employees to complete the designated employers verification form and present documentation to certify that you are eligible for employment as a United States citizen or alien authorized to work in the United States.

This application will be retained in our active files for sixty (60) days. If you wish to submit another application after this period of time, please feel free to do so. I agree to abide by all the rules of the company and will obey the orders and the instructions of my supervisor. I will use and wear all safety appliances furnished me by the company and will be careful in my work, and not expose myself or other workers to unnecessary dangers.

I certify that this application was completed by me, and that all information contained in this application is true and complete to the best of my knowledge and belief. I understand and agree that any false information, misrepresentations or omissions of any kind may result in denial of employment or be cause for subsequent dismissal if I am hired.

I authorize Sendik's Fine Foods, Inc. to investigate my responses on this application and contact any or all of my former employers or any individuals familiar with me or my employment background for the purpose of verifying any information I have provided and/or for the purpose of obtaining any information, whether favorable or unfavorable, about me or my employment. I voluntarily and knowingly fully release and hold harmless any person or organization that provides information pertaining to me or my employment.

Regardless of whether or not I become employed by Sendik's Fine Foods, Inc., I recognize that this application is not and should not be considered a contract of employment. I understand that employment at Sendik's Fine Foods, Inc. is on an at will basis and that my employment may be terminated with or without cause, and without notice, at my option or the company's unless specifically provided otherwise in a written employment contract.