test emp form

Employment Application

McKay’s Market provides equal employment opportunities to all qualified employees and applicants, without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, veteran status, or any other status protected by applicable federal, Oregon, or local law.

IF HIRED, THIS APPLICATION WILL BECOME PART OF YOUR PERMANENT PERSONNEL FILE. PLEASE COMPLETE LEGIBLY. YOUR APPLICATION MAY NOT BE CONSIDERED IF INCOMPLETE OR SUBMITTED PAST AN ESTABLISHED DEADLINE.

Date of Application(Required)

POSITION

Position(s) Applying For(Required)

(be specific – max 3)

Location applying for

Available Start Date(Required)

Hours you would work?(Required)

Full Time

Part Time

Specify days & hours you can not work

PERSONAL INFORMATION

Name(Required)

First Last

Phone(Required)

(###)###-####

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Are you able, at the time of employment, to submit verification of your legal right to work in the United States?(Required)

Yes

(proof of identity will be required upon employment)

Can you drive or travel if the job requires it?(Required)

Yes

Will you have any difficulty getting to and from work?(Required)

Yes

Do you have any friends or relatives working for us?(Required)

Yes

if yes, whom, and where do they work

Have you ever worked for this company?

Yes

If so, when?(Required)

Availability

List approximate times available next to each day. (ex. Monday: 3pm to 10pm)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Education

High School

Address

Street Address Address Line 2 City State ZIP Code

Degree

College

Address

Street Address Address Line 2 City State ZIP Code

From

Degree

Other

Address

Street Address Address Line 2 City State ZIP Code

From

Degree

References

Name

First Last

Relationship

Company

Phone

Name

First Last

Relationship

Company

Phone

Name

First Last

Relationship

Company

Phone

Employment History

Please list all present and past employers. Begin with your most recent.

Present/Last Employer

Phone

Address

Street Address City State ZIP Code

Supervisor

Job Title

Responsibilities

Start Date

MM/DD/YYYY

End Date

MM/DD/YYYY

Reason For Leaving

Present/Last Employer

Phone

Address

Street Address City State ZIP Code

Supervisor

Job Title

Responsibilities

Start Date

MM/DD/YYYY

End Date

MM/DD/YYYY

Reason For Leaving

Present/Last employer

Phone

Address

Street Address City State ZIP Code

Supervisor

Job Title

Responsibilities

Start Date

MM/DD/YYYY

End Date

MM/DD/YYYY

Reason For Leaving

Military Service

Branch

From

Rank at Discharge

List of duties in the service including special training?

Have you taken any training under the G.I. Bills of Rights

If yes, what training did you take

CERTIFICATION & SIGNATURE

I hereby certify that all statements made in this application are true. I agree and understand that any statement that is false, fraudulent, or misleading in this application or attached material, during the interview or prescreening process, or discovered during any employment-related process (post-hire) may result in the revocation of a job offer or termination of employment.

• I certify that all statements contained herein are true and complete.
• I understand that I must provide proof that I am authorized to work in the United States, in accordance with federal law, if I am hired.
• I authorize my driving record to be checked if the position for which I am applying involves driving.

I can perform the essential duties of this position as advertised, with or without reasonable accommodation(Required)

Yes

No, Please Explain:

If No, Please Explain(Required)

Signature (type name)(Required)

Date(Required)

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