Employment Application
Rebecca’s Natural Food will not discriminate against any employee or applicant for employment because of age (as defined by applicable law), religion, sex, race, color, national origin, or because they are physically challenged, a disabled veteran or a Vietnam era veteran.  Answers to the application questions will be utilized for applicable job-related information only.
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Email *
Name (last, first, middle initial): *
Present Address (street, city, state, zip): *
Permanent Address (if applicable):
Phone: *
Referred by:
Position Desired *
Date you can start: *
MM
/
DD
/
YYYY
Desired salary
What kind of employment do you want? *
What days and hours are you available to work?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
8:30am
9:30am
10:30am
11:30am
12:30pm
1:30pm
2:30pm
3:30pm
4:30pm
5:30pm
6:30pm
7:30pm
8:30pm
Are you employed now *
If so, may we contact your current employer? *
Do you have reliable transportation? *
In case of emergency, notify (name, phone #):
Education-- High School (name, location, years attended): *
High School-- did you graduate? *
Education-- College (name, location, years attended):
College-- did you graduate?
Clear selection
Education-- Other (name, location, years attended, degree/certification?):
Subjects of special study or interest
Why do you want to work at Rebecca's? *
Reference (name, phone number, business, years acquainted): *
Reference (name, phone number, business, years acquainted): *
Reference (name, phone number, business, years acquainted): *
What do you know about Rebecca's? *
What do you expect out of this job? *
What do you consider your responsibilities as a co-worker to be? *
How do you feel about approaching customers?
Are you willing to work one 8-hr weekend shift per week? *
How do you define customer service? *
What do you consider being late for work? *
Required
Are you looking for a temporary or long-term *
Are you looking for a part-time or full-time position? *
How do you describe your ideal work environment? *
Former Employment-1 (name and address): *
Former Employment-1 (years you worked there): *
Former Employment-1 (position and salary): *
Former Employment-1 (reason for leaving): *
Former Employment-1 Contact (name and phone number): *
Former Employment-2 (name and address):
Former Employment-2 (years you worked there):
Former Employment-2 (position and salary)
Former Employment-2 (reason for leaving):
Former Employment-2 Contact (name and phone number):
Former Employment-3 (name and address):
Former Employment-3 (years you worked there):
Former Employment-3 (position and salary):
Former Employment-3 (reason for leaving):
Former Employment-3 Contact (name and phone number):
I authorize investigation of all statements contained in this application.  I understand that misrepresentation or omission of facts called for is cause for dismissal.  I further understand and agree that my employment is for no definite period and may, regardless if the date of payment of my wages and salary, be terminated at any time without any previous notice (sign and date): *
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