Employment Application

Personal Information
Please select the store you are applying to*
Name
First Last
Phone
Email
Address
Street Address Address Line 2 City State ZIP Code
How long have you lived at this address?
Are you under the age of 18?
If under 18, can you supply a work permit?*
What position(s) are you applying for?
How did you find out about this job?
Are you legally eligible for employment in the U.S.?
Have you ever been found guilty of a crime?
Are you currently on parole?
Are you currently awaiting trial?
Are you currently on deferred adjudication?
If you answered yes to any of the previous 4 questions, please explain the nature and disposition of the case:*
Employment Data
What kind of work are you seeking?
- Full Time
- Part-Time
- Temporary
Please check all that apply.
Availability
Day From To

Please list the specific day and hours you would be available for work.
Please list any shifts you can not work?
Are you currently employed?
If so, who is your current employer?*
When are you available to work at Gowell's Shop 'n Save?
MM slash DD slash YYYY
Have you ever been employed at Gowell's Shop 'n Save?
If yes, when?*
Please list any friends or relatives that work at Gowell's Shop 'n Save:
Education & Experience
What is the highest level of education you've completed?
Please describe your course of study or other training or education:
Are you currently attending school?
Work History
Please list your last three employers, starting with the most recent.
May we contact the employers listed below?
Most Recent Employer Name
Start Date
End Date
Address
Street Address Address Line 2 City State ZIP Code
Phone
Job Title / Position
Starting Salary
Ending Salary
Reason For Leaving
Second Most Recent Employer Name
Start Date
End Date
Address
Street Address Address Line 2 City State ZIP Code
Phone
Job Title / Position
Starting Salary
Ending Salary
Reason For Leaving
Third Most Recent Employer Name
Start Date
End Date
Address
Street Address Address Line 2 City State ZIP Code
Phone
Job Title / Position
Starting Salary
Ending Salary
Reason For Leaving
Personal References
Reference 1
Please include at least name & phone number.
Reference 2
Please include at least name & phone number.
Reference 3
Please include at least name & phone number.
Specialized Supermarket Experience
Please describe any specific experience that would help you if you were hired at Gowell's Shop 'n Save.
Meat or Seafood Department
Produce or Bulk Food Department
Bakery Department
Deli Department
Kitchen or Restaurant
Cashier or Bagger
Grocery Department or Night Stocker
Dairy or Frozen Food Department
Voluntary Information
You are not required to complete this information in order to be considered for employment at Gowell's Shop 'n Save. This is voluntary only!
Sex
Date of Birth
MM slash DD slash YYYY
Electronic Signature
I authorize this company to make an investigation of all information contained in this employment application and I release from liability all companies and corporations supplying such information. I understand any false answers, statements or implications made by me on this application or any other required documents shall be considered sufficient cause for denial of employment or discharge. I hereby agree to submit to any drug/alcohol testing required of me, whether prior to employment or if employed by this company, at anytime thereafter.
Type Name

Day	From	To

Employment Application

Personal Information

Employment Data

Education & Experience

Work History

Personal References

Specialized Supermarket Experience

Voluntary Information

Electronic Signature