Employment - Donelan's Supermarkets

Name*

Address1*

Address2

City*

State*

Zip

State*

Zip*

Phone*

Email*

Are you 18 years or older?*

YesNo

Are you 16 or 17 years old?

YesNo

Full time or Part time position?*

Full timePart timeSummer Only

Position applied for*

Date you can start*

Salary desired*

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

Monday*

Tuesday*

Wednesday*

Thursday*

Friday*

Saturday*

Sunday*

Are you willing to work overtime?**

YesNo

Are you willing to work evenings?*

YesNo

Are you willing to work weekends?*

YesNo

Preferred Work Location*

If hired, are you able to furnish proof of legal eligibility to work in the U.S. in accordance with the Immigration & Reform Act?*

YesNo

If under 18, do you have necessary work permits? Only answer if under 18.

YesNo

Are you employed now?*

YesNo

If so, may we inquire with present employer?

YesNo

Were you referred for employment by a current Donelans employee?

YesNo

If so, by whom?

List below last three employers: (in most recent order):

Employer 1

Date started and ended: (mm/yyyy)

Name and address of employer?

Salary?

Position?

Reason for leaving?

Employer 2

Date started and ended: (mm/yyyy)

Name and address of employer?

Salary?

Position?

Reason for leaving?

Employer 3

Date started and ended: (mm/yyyy)

Name and address of employer?

Salary?

Position?

Reason for leaving?

Have you been employed by Donelans Supermarkets, Inc in the past?

YesNo

If yes, which location(s)?

Education (High School):

Name/Local of School

Years attended

Did you graduate?

Subjects Studied?

Education (College):

Name/Local of School

Years attended

Did you graduate?

Subjects Studied?

Education (Trade, Business School):

Name/Local of School

Years attended

Did you graduate?

Subjects Studied?

Special training or skills that would be of benefit in the job for which you are applying:

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, in employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

I understand and agree that if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, by terminated at any time without any prior notice.

By typing your name below you consent to the statements above. The field below acts as your legal signature. *

This application of employment is not intended to be a contract of employment.

Page Title

List below last three employers: (in most recent order):

Employer 1

Employer 2

Employer 3

Education (High School):

Education (College):

Education (Trade, Business School):

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