Jake's Market & Deli Employment Application
* Required
Applicant Full Name:
*
Your answer
Date of Application:
*
Your answer
Home Street Address:
*
Your answer
City/State/ZIP:
*
Your answer
Phone Number:
*
Your answer
E-Mail:
*
Your answer
Social Security Number:
*
Your answer
What position are you applying for?
*
Your answer
Please specify location of position
Lebanon, NH
Walpole, NH
New London, NH
Georges Mills, NH
Canaan, NH
Enfield, NH
Hartford, VT
Hartland, VT
Springfield, VT
Full or Part Time?
*
Full time
Part time
Who referred you to our company?
Your answer
Do you have any friends or relatives who work here? If yes, please list below:
Your answer
Have you worked at Jake's previously? If yes, when and where?
*
Your answer
Are you at least 18 years old?
*
Yes
No
Are you willing to work any shift, including nights and weekends? If no, please list any limitations.
*
Your answer
If you are offered employment, when would you be available to begin work?
*
Your answer
If hired, are you able to submit proof that you are legally eligible for employment in the United States?
*
Yes
No
Are you able to perform the essential function of the job position you seek with or without reasonable accommodation?
*
Yes
No
What reasonable accommodation, if any, would you require?
Your answer
Have you ever been convicted of a felony?
*
Yes
No
If yes, please list your conviction, the date you were convicted, and in what city/state you were convicted.
Your answer
List any skills that may be useful for the job you are seeking along with the number of years of experience, and rate your ability for each skill 1-5 with 1 being poor ability and 5 being exceptional ability.
*
Your answer
Please list your employment history with the NAME OF YOUR EMPLOYER, SUPERVISOR'S NAME, CITY/STATE, POSITION, REASON FOR LEAVING, DATES OF EMPLOYMENT (month/years) beginning with most recent employment:
*
Your answer
Did you graduate from High School or receive your GED?
*
Yes
No
Other:
Did you graduate from College/University? If yes, what degree did you receive?
Your answer
Do you have other training (graduate, technical, vocational)?
*
Your answer
Please list 3 NON-RELATIVES who would be willing to provide a reference for you. Include their NAME, PHONE NUMBER, and YEARS KNOWN:
*
Your answer
I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination. I authorize Sugar Face & Company, LLC & KB Ventures, Inc. to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education. If any employment is offered I understand the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause, except as may be required by law.With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the same right. This application does not constitute an agreement or contract for employment. I understand if I'm hired I will be required to provide proof of identity and legal work authorization. I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS. Please digitally sign and date below:
*
Your answer
Submit
Never submit passwords through Google Forms.
Forms
This content is neither created nor endorsed by Google.
Terms of Service