Short Stop Food Marts Employment Application

Please select the store to which you are applying:


Job Interest
List below any skills and/or training that may be important in considering you for employment:


Personal Information
Email address (not required)
Social Security Number
Last name, First name, MI
Current address Street & Number
City State Zip
Previous address
(If resided at current address for less than 2 years) 		Street & Number
City State Zip
Home phone number           Alternate Phone Number
Position applying for
Expected Pay      Date Available to Start
Have you ever applied for a job with Short Stop? Yes   No      If yes, when/where
Were you previously employed with Short Stop? Yes   No      If yes, when/where
Are you at least 21 years of age? Yes   No   
How did you here about our organization?
Have you ever ben discharged from a job? Yes   No
Are you currently Employed?  Yes   No     
A student?   Yes   No    
On leave of absence?   Yes No

If an offer of employment is made to you, can you provide evidence of identity and work authorization as required by the Immigration Reform and Control Act?
Yes   No
   
List any friends who work for Short Stop: (Please include their names, store locations in which they work, and their relationship to you)

Have you ever been convicted of a felony or misdemeanor, except a minor traffic violation, in the last seven (7) years?
Yes   No
If yes, explain: (Note:  A conviction will not necessarily disqualify you from employment)

Availability

What type of employment are you seeking?
Full-time (More than 35 hours per week)
Part-time (Less than 35 hours per week)

Number of hours you would prefer to work each week:
Maximum number of hours you can work each week:

If hired, the hours you listed will be taken into consideration in our scheduling process. If you have any conflicts, please list them below:


To help us consider you for a job that matches your availability, please tell us the earliest and the latest time you can work each day by filling out the chart below:

Day Earliest Time Latest Time
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
 

Work History
List work history below beginning with the current or most recent employers and military service.

Company Name Position Starting Date (mm/yy)
Address Supervisor Date of Leaving (mm/yy)
City, State, Zip Reason you left Pay at Hire per
Telephone Eligible for re-employment Yes   No Pay at Leaving per

Company Name Position Starting Date (mm/yy)
Address Supervisor Date of Leaving (mm/yy)
City, State, Zip Reason you left Pay at Hire per
Telephone Eligible for re-employment Yes   No Pay at Leaving per


Company Name Position Starting Date (mm/yy)
Address Supervisor Date of Leaving (mm/yy)
City, State, Zip Reason you left Pay at Hire per
Telephone Eligible for re-employment Yes   No Pay at Leaving per

 

Company Name Position Starting Date (mm/yy)
Address Supervisor Date of Leaving (mm/yy)
City, State, Zip Reason you left Pay at Hire per
Telephone Eligible for re-employment Yes   No Pay at Leaving per

 

Company Name Position Starting Date (mm/yy)
Address Supervisor Date of Leaving (mm/yy)
City, State, Zip Reason you left Pay at Hire per
Telephone Eligible for re-employment Yes   No Pay at Leaving per

State the reason and length of any inactivity between employers:

May we contact your present employer for a work reference?   Yes   No
To assist us in verifying your prior employment, have you ever worked under another name?    Yes    No
If yes, please list the name:  

Education
List all High School, College, University or Technical Training Years Completed Did You Graduate? Degree or Certificate
Y   N
Y   N
Y   N

 

IMPORTANT
APPLICANTS AGREEMENT AND CERTIFICATION
READ BEFORE SUBMITTING THE APPLICATION

I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge.   I understand that, if employed, falsified statements on this application shall be considered sufficient cause for dismissal.  I hereby authorize all my previous employers to furnish any information concerning my personal character, work habits or employment record, and I release all such persons from liability for damages incurred as a result of furnishing such information.

I understand that I will be required to undergo screenings for substance abuse (drugs) as a condition of my employment.  I also understand that any employment relationship entered into between myself and Short Stop shall be for an indefinite term and said employment shall be terminable at the will of either party without cause.

Short Stop is an equal opportunity employer.  Our policy is to consider all applicants for employment based on their qualifications and our current job vacancies.  Applicants are considered without regard to race, color, religion, sex, national origin, age or disability.

To certify that you understand the above agreement please click on "Submit Application for Processing"