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*First name

*Last name

Former name (if any)

*Birthday

Month

Day

Year

*Present address

*Phone

*Best time to call?

*Email

*Position Desired (select multiple if willing)

Deli (6:00am-2:00pm)

Deli (2:00pm-9:30/10:30pm)

Cashier (6:30am-3:00pm)

Cashier (2:30pm-11:00pm)

*Which would you accept?

Part time

Full time

Either

*Date able to start

*Desired minimum hourly rate

*Are you currently employed?

Yes

If yes, may we contact them?

Yes

*Have you ever applied with us before?

Yes

If yes, when?

*What prompted you to seek us for employment?

Name any friend or relative employed with our company and your relationship

Current U.S. Military or Naval service

Length of service, rank, and branch

Present membership in the national guard or reserves?

*Have you ever been bonded?

Yes

*Have you ever been convicted of a crime?

Yes

If yes, please explain when, where, and the nature of the offense(s)

*Are there any felony charges pending against you?

Yes

If yes, please describe

*Is there any position for which you should not be considered or job duty, which you could not perform?

Yes

If yes, please explain

*Have you ever received any form of compensation for injuries?

Yes

If yes, please explain

*Education

Grammar School

High School

College

Trade, business or correspondence

Other

*Name of schools, years attended, and if you graduated

*List your last three employers, starting with the last one first. Include the following: Month and date from-to, Name & address, Salary/hourly rate, Position, Reason for leaving

*Which of these jobs did you like best? Explain why:

*Which of these jobs did you like the least? Explain why:

*Describe skills, qualifications, experiences, activities, or other information that you feel would be helpful in considering you for a position?

*List three references and include the following: Name, address, phone #, business, years known

I certify that the information provided in this application is true and accurate to the best of my knowledge.

*Signature

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Frank's Food Mart-BP

517-645-7665

517-645-7666

franksfoodmartbp@gmail.com

117 E Lansing Rd

Potterville, MI 48876

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