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
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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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