Dan's Supermarket

Personal Information

Today's Date:

9/2/2010

Last Name:

First Name:

Middle Name:

Address:

City:

State:

Zip:

Home Phone:

Business Phone:

Email:

Have you ever applied for employment with us?

yes no	If Yes, Month and Year:
yes no	Location:

Have you previously worked for us?

yes no	If Yes, Month and Year:
yes no	Location:

Position(s) Desired:

Store Location Desired:

Pay Expected:

Number of hours you would like to work weekly :

Availability:

	MON	TUES	WED	THUR	FRI	SAT	SUN
FROM
TO
This work schedule preference is for information purposes only and does not create a right to work these hours nor establishes any obligation upon Dan's to schedule you during the hours listed.

Will you work overtime if asked?

yes
no

When will you be available to begin work?

Are you legally eligible for employment in the United States?

yes
no

Other special job related training or skills (languages, machine operation, etc.)

How did you learn of our organization?