Employment Application: DiOrio's Supermarket

Personal Information

Name:*

Address:*

City:*

State:*

Zip:*

Phone:*

Alternate Phone:

Are you older than 18?:* Yes No

If not, date of birth:

How did you learn about our company?:*

Availability

Available Start Date:*

Are you currently employed?:* Yes No

Total hours available per week:*

Days available:

Are you legally able to be employed in the US?:* Yes No

How far do you live from Old Forge?:*

Do you have reliable transportation?:* Yes No

Do you smoke?:* Yes No

Are you able to lift 50 lbs?:* Yes No

Do you have any prior injuries that could affect your ability to work?:* Yes No

If yes, please explain:

During the past 5 years, have you been convicted of a crime?:* Yes No

Do you have children?:* Yes No

If yes, do you have reliable childcare?: Yes No

Education

High School Name and Location

Graduated?:* Yes No

Now Enrolled?:* Yes No

College Name and Location

Graduated?: Yes No

Please list your areas of highest proficiency, special skills or other items that may contribute to your abilities in performing the above mentioned position.:*

***PLEASE NOTE THAT WE DO NOT ALLOW VACATIONS DURING JULY AND AUGUST!

Previous Experience

Please list beginning from most recent.

Dates Employed*

Company Name and Location*

Role/Title*

Job notes, tasks performed and reason for leaving:*

Dates Employed

Company Name and Location

Role/Title

Job notes, tasks performed and reason for leaving: