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Price Chopper Job Application Form

To join a Price Chopper supermarket as an employee, applicant must fill out this form and submit it to the manager of the desired store.Download

Extracted Text for Proper Search

PRICE CHOPPER	
APPLICATION FOR EMPLOYMENT 	
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?)	
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 ___________________ 	
We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, disability or any  other legally protected status.   	
EDUCATION

COMPANY NAME _____________________________	SUPERVISOR ____________________________________________	
ADDRESS _______________________________________	DATES EMPLOYED: From _______________ To ____________________	
TELEPHONE _____________________________	RATE OF PAY: START ______________ LAST __________________	
STATE JOB TITLE AND DESCRIBE YOUR WORK______________________________________________________________ 
______________________________________________________________________________________________
REASON FOR LEAVING _____________________________________________________________________________
COMPANY NAME _____________________________	SUPERVISOR ____________________________________________	
ADDRESS _______________________________________	DATES EMPLOYED: From _______________ To ____________________	
TELEPHONE _____________________________	RATE OF PAY: START ______________ LAST __________________	
STATE JOB TITLE AND DESCRIBE YOUR WORK______________________________________________________________ 
______________________________________________________________________________________________
REASON FOR LEAVING _____________________________________________________________________________
COMPANY NAME _____________________________	SUPERVISOR ____________________________________________	
ADDRESS _______________________________________	DATES EMPLOYED: From _______________ To ____________________	
TELEPHONE _____________________________	RATE OF PAY: START ______________ LAST __________________	
STATE JOB TITLE AND DESCRIBE YOUR WORK______________________________________________________________ 
______________________________________________________________________________________________
REASON FOR LEAVING _____________________________________________________________________________
MAY WE CONTACT THESE EMPLOYERS? YES _________  NO _________  HAVE YOU EVER BEEN CONVICTED OF, OR PLEADED GUILTY TO A FELONY? YES ______ NO  _________ 
If yes, describe in full.  Convictions will not necessarily disqualify an applicant from employment.
____________________________________________________________________________________________ __________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________ ( PLEASE PRINT PLAINLY )	
___________________________________________	
LIST PRESENT EMPLOYER OR MOST RECENT EMPLOYER FIRST 	
Date 	
Occasionally the form of an application blank makes if difficult for individuals to adequately summarize their 
complete background. With that in mind please list any other special skills or qualifications that you would like usto consider. 
IMPORTANT: READ CAREFULLY 	
Applicant's Signature   	
I certify that the information contained in this application is correct to the best of my knowledge. If employed, I understand 
that the falsification of this information may result in my dismissal. I authorize the investigation of all statements contained in
this application for employment as necessary in arriving at an employment decision. I understand that my employment may
be terminated, with or without notice, by the Company for any reason, including lack of work, unsatisfactory performance, 
improper behavior or any other reason which, in the sole judgment of the Company, constitutes a basis for termination	
of	
employment.     	
___________________________________________
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