Online Application for Haddad’s West Peoria Market

1

Date:

Name:

Telephone: (            )

Address:

Postal Code:

Social Security Number: #

Position(s) applied for:

______Full Time _______Part Time________Temporary

Date you are available for employment:

Wage or salary desired:

Have you ever worked for Haddads' Market before?

If yes, when?

2

EDUCATIONAL BACKGROUND

EDUCATIONAL BACKGROUND – relevant to the position applied for

Highest level of education completed:

Name of educational institute:

What machines or equipment have you operated, which relate to the position, you have applied for?

Are there any skills, experience, of other qualifications, which you feel would assist you in performing the duties of the position you have applied for?

3a

List below your last three employers, starting with the most recent.

Employer’s Name:

Commencement Date:

Departure Date:

Reason for Departure:

Supervisor’s Name:

Telephone: (            )

Position(s) Held:

Duties:

May we contact this employer? (If not, state brief reason):

3b

Employer’s Name:

Commencement Date:

Departure Date:

Reason for Departure:

Supervisor’s Name:

Telephone: (            )

Position(s) Held:

Duties:

May we contact this employer? (If not, state brief reason):

3c

Employer’s Name:

Commencement Date:

Departure Date:

Reason for Departure:

Supervisor’s Name:

Telephone: (            )

Position(s) Held:

Duties:

May we contact this employer? (If not, state brief reason):

4

If you are applying for a position that requires driving, please complete this section:

Do you have a valid drivers license?

License #:

State:

Note: If you are selected for an interview, you are required to present a copy of your driving record that is not more than 4 weeks old. After being hired, a copy of this driving record will be placed into your personnel file and an annual update will be required.

5

Have you ever lost time from work because of an accident? If yes, explain.

Have you ever collected workman’s compensation benefits?

Are you willing to take a Physical Examination at our expense?

Do you have any physical limitations, which could affect your job performance? If yes, explain.

6

False information given or implied on an application form is grounds for immediate dismissal without further notice.

I hereby state that all information provided is accurate and may be verified by you. I agree that I may be discharged if Haddads' Market at any time learns of falsification or material omission in the information provided on this application form and related documents. Haddads' Market may contact my former employer in connection with the consideration of my employment with them. All references are hereby authorized to release all information which they may have relevant to my employment with them. I hereby release Haddads' Market its affiliates, successors, and assigns, and all references from any liability that might be claimed because of information provided by such references.

I agree that I will follow all Company policies, rules, procedures, and all other directions pertaining to my employment. I understand that Haddads' Market reserves the right to add, change, and/or delete any policies, procedures, work rules, and/or benefits at any time.

Applicant Signature:

Date:

NO CONSIDERATION OF EMPLOYMENT WILL BE GIVEN TO ANY APPLICANT WHO DOES NOT SIGN THE ABOVE STATEMENT.

Note: Additional personal information will be required to complete benefit forms after being hired.

Thank you for showing an interest in pursuing a career with Haddad's Market