Lyons Market/Buddy's IGA Job Application

Please fill out the form below. We will contact you as soon as your application is processed.

Location Applying for: *
Personal Details
Name Name * First Middle Last
Have you ever used any other name which is necessary for us to know to enable us to verify your employment or education? Provide name.
Contact Details
Email
Current Address Current Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Previous Address if you have been at your current address for less than 24 months Previous Address if you have been at your current address for less than 24 months
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Primary Phone No. Primary Phone No. * - ### - ### ####

Include Area Code
Alternate Phone No. Alternate Phone No. - ### - ### ####

Include Area Code
Work Phone Work Phone - ### - ### ####
Are you 18 years or older? *

Are you 18 years or older? Yes No
Do you currently Smoke or Vape? *

Do you currently Smoke or Vape? Yes No
In Case of Emergency, Notify
Contact's Name *
Contact's Address *
Contact's Phone Contact's Phone * - ### - ### ####

Include Area Code
Relationship to you: *
Employment Information
If offered a position, when would you be able to start work? If offered a position, when would you be able to start work? / MM / DD YYYY
Have you applied for employment or worked for us before? *

Have you applied for employment or worked for us before? Yes No
If yes, when and where?
For what position?
Do you have a relative who has or now works for us? *

Do you have a relative who has or now works for us? Yes No
If yes, who and where?
Position Applying For: *
Do you have unrestricted right to accept employment in the United States *

Do you have unrestricted right to accept employment in the United States Yes No
Will you need to petition for continued work authorization in the future? *

Will you need to petition for continued work authorization in the future? Yes No
Prefer *

Prefer Full Time Part Time
If yes, what hours in the day or days of the week can you work?
Maximum of 110 characters allowed. Currently Entered: 0 characters.
Will you be able to perform the essential functions of the job applied for with or without a reasonable accommadation? *

Will you be able to perform the essential functions of the job applied for with or without a reasonable accommadation? Yes No
Your desired hourly rate?
or desired Annual Salary?
Background Information
Have you ever pled "guilty" or "no contest" to, or been convicted of a felony or misdemeanor? Do not include minor traffic offenses. A conviction will not automatically exclude an applicant from employment. *

Have you ever pled "guilty" or "no contest" to, or been convicted of a felony or misdemeanor? Do not include minor traffic offenses. A conviction will not automatically exclude an applicant from employment. Yes No
If you answered yes, provide:
Date of conviction.
Type of conviction:

Type of conviction: Felony Misdemeanor
Nature of offense
Are any charges currently pending against you? *

Are any charges currently pending against you? Yes No
If yes, please describe:
Have you ever been discharged from a position or resigned to avoid discharge? *

Have you ever been discharged from a position or resigned to avoid discharge? Yes No
If you answered yes, please describe the circumstance.
Education

(High School and above, including Technical Schools)
Name & Location of School
No. Years
Did you Graduate?

Did you Graduate? Yes No
Degree or Field of Study
Name & Location of School
No. Years
Did you Graduate?

Did you Graduate? Yes No
Degree or Field of Study
Name & Location of School
No. Years
Did you Graduate?

Did you Graduate? Yes No
Degree or Field of Study
Name & Location of School
No. Years
Did you Graduate?

Did you Graduate? Yes No
Degree or Field of Study
Skills, Training and Experience
Please list any special qualifications, skills, training or experience that you feel warrant consideration by the company:
Have you ever served in the U.S. Armed Forces? *

Have you ever served in the U.S. Armed Forces? Yes No
If yes, list any duties and/or special training that is relevant to the position for which you have applied:
PERSONAL/PROFESSIONAL REFERENCES

Do not list relatives or family members.
Name *
Phone Phone * - ### - ### ####

Include Area Code
How are you acquainted? *
Years acquainted *
Email Address
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Name *
Phone Phone * - ### - ### ####

Include Area Code
How are you acquainted? *
Years acquainted *
Email Address
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Name *
Phone Phone * - ### - ### ####

Include Area Code
How are you acquainted? *
Years acquainted *
Email Address
EMPLOYMENT HISTORY

Provide all information. Incomplete applications will not be considered for employment.
Employer's Name

(List current or last employer first)
Employer's Phone No. Employer's Phone No. * - ### - ### ####

Include Area Code
Supervisor's Name *
Last Job Title *
Full or Part Time *

Full or Part Time Full Time Part Time
From Month/year *
To Month/Year (Input Current if you still work there) *
Were you Discharged? *

Were you Discharged? Yes No
Reason for leaving or circumstances of discharge. *
Ending Base Pay *
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Employer's Name

(List current or last employer first)
Employer's Phone No. Employer's Phone No. * - ### - ### ####

Include Area Code
Supervisor's Name & Title *
Full or Part Time *

Full or Part Time Full Time Part Time
Last Job Title *
From Month/year *
To Month/Year *
Were you Discharged? *

Were you Discharged? Yes No
Reason for leaving or circumstances of discharge. *
Ending Base Pay *
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Employer's Name

(List current or last employer first)
Employer's Phone No. Employer's Phone No. * - ### - ### ####

Include Area Code
Supervisor's Name *
Full or Part Time *

Full or Part Time Full Time Part Time
Last Job Title *
From Month/year *
To Month/Year *
Were you Discharged? *

Were you Discharged? Yes No
Reason for leaving or circumstances of discharge.
Ending Base Pay *
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Employer's Name

(List current or last employer first)
Employer's Phone No. Employer's Phone No. * - ### - ### ####

Include Area Code
Supervisor's Name *
Full or Part Time *

Full or Part Time Full Time Part Time
Last Job Title *
From Month/year *
To Month/Year *
Were you Discharged? *

Were you Discharged? Yes No
Reason for leaving or circumstances of discharge. *
Ending Base Pay *
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Can present Employer be contacted *

Can present Employer be contacted Yes No
Which of the above jobs did you like best? *
What did you like most about that job? *
APPLICANT STATEMENT

(Read the following very carefully before you sign this Application. Your signature confirms that you have read and understand the following.)
I represent and warrant that I am not subject to any contract or agreement that would prevent me from working for the Company, including any non-compete agreement or covenant not to compete.
I understand and acknowledge that nothing contained in this application or in any other document authored by or provided by the Company s intended to or will create a promise to employ, an employment contract or any other type of contract between myself and the Company. I further understand and acknowledge that no verbal statement, including verbal statements made during any interview that may be granted, is intended to or will create a promise to employ, an employment contract or any other type of contract between myself and the Company.
I understand and acknowledge that if I am employed by the Company, my employment is at-will and for no definite or determinable time period and may be terminated at any time, with or without prior notice or cause, by either myself or the Company and affiliated companies. No one other than the Chief Executive Officer (CEO) has the authority to change the at-will nature of employment with the Company and CEO may do so only in a writing that is signed by both the CEO and myself. No other document can alter the at-will nature of employment with the Company. Similarly, no verbal statement or promise can alter the at-will nature of employment with the Company.
I understand that the employer will thoroughly investigate my work and personal history and verify all data given on this application, on related papers, and in interviews. I authorize all individuals, schools, and firms named therein, except my current employer if so noted, to provide any information requested about me, and I release them from all liability for damage in providing this information.
I understand that federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity. Failure to submit such proof will result in denial of employment.
I understand this application will be active for a period of sixty days. After that time, if I wish to be considered for employment, I must submit a new application.
I certify that all the statements herein are true and understand that any falsification, misrepresentation, or willful omission shall be sufficient cause to refuse offer of employment or constitute grounds for dismissal at any time during my employment. I voluntarily and knowingly authorize investigation of any information presented.
I certify that I have read and fully understand and accept all terms of the above Applicant Statement *

I certify that I have read and fully understand and accept all terms of the above Applicant Statement I Agree
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Lyons Market/Buddy's IGA Job Application

Lyons Market/Buddy's IGA Job Application

Personal Details

Contact Details

In Case of Emergency, Notify

Employment Information

Background Information

Education

Skills, Training and Experience

PERSONAL/PROFESSIONAL REFERENCES

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

EMPLOYMENT HISTORY

APPLICANT STATEMENT