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.
Email address *
Name (last, first, middle initial): *
Your answer
Present Address (street, city, state, zip): *
Your answer
Permanent Address (if applicable):
Your answer
Phone: *
Your answer
Referred by:
Your answer
Position Desired *
Your answer
Date you can start: *
MM
/
DD
/
YYYY
Desired salary
Your answer
What kind of employment do you want? *
What days and hours are you available to work?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
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 #):
Your answer
Education-- High School (name, location, years attended): *
Your answer
High School-- did you graduate? *
Education-- College (name, location, years attended):
Your answer
College-- did you graduate?
Education-- Other (name, location, years attended, degree/certification?):
Your answer
Subjects of special study or interest
Your answer
Why do you want to work at Rebecca's? *
Your answer
Reference (name, phone number, business, years acquainted): *
Your answer
Reference (name, phone number, business, years acquainted): *
Your answer
Reference (name, phone number, business, years acquainted): *
Your answer
What do you know about Rebecca's? *
Your answer
What do you expect out of this job? *
Your answer
What do you consider your responsibilities as a co-worker to be? *
Your answer
How do you feel about approaching customers?
Your answer
Are you willing to work one 8-hr weekend shift per week? *
How do you define customer service? *
Your answer
What do you consider being late for work? *
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? *
Your answer
Former Employment-1 (name and address): *
Your answer
Former Employment-1 (years you worked there): *
Your answer
Former Employment-1 (position and salary): *
Your answer
Former Employment-1 (reason for leaving): *
Your answer
Former Employment-1 Contact (name and phone number): *
Your answer
Former Employment-2 (name and address):
Your answer
Former Employment-2 (years you worked there):
Your answer
Former Employment-2 (position and salary)
Your answer
Former Employment-2 (reason for leaving):
Your answer
Former Employment-2 Contact (name and phone number):
Your answer
Former Employment-3 (name and address):
Your answer
Former Employment-3 (years you worked there):
Your answer
Former Employment-3 (position and salary):
Your answer
Former Employment-3 (reason for leaving):
Your answer
Former Employment-3 Contact (name and phone number):
Your answer
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): *
Your answer
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google.