JOB APPLICATION: HARVEST CO-OP MARKETS

YOUR PERSONAL INFORMATION:

(Fields marked with a * are required)
Name:
Street Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Email:
Are you a student? yes             no
Are you over 18 years of age?: yes              no

(Please note that if you are under 18 years of age, you must provide a work permit from your school)
If hired, can you furnish documentation proving that you are authorized to work in the United States? yes              no
When are you available to start? MM/DD/YYYY
Wage/Salary expected?
Have you ever worked at the Co-op before? yes              no
Have you ever been convicted of a felony? (conviction of a felony will NOT automatically disqualify you from employment) yes              no
If 'yes, please explain:

EDUCATION AND SKILLS:

Education:

Highschool:
City/State

Did you graduate? yes           no

College:
City/State

Program or Major

Degree or Certificate received

List any specific skills, education, experience or qualifications you have that you feel would be useful in the position you are applying for:

JOB HISTORY:
List your last 3 employers. Complete all sections, including contact numbers. You may include volunteer positions, if you wish.

JOB 1:
Dates employed (mm/dd/yy):

from       to
Company Name and Address:

Supervisor Name:

     
Supervisor Contact Number:
Salary: $ start       $ end

Reason for Leaving:
May we contact? yes          
 

JOB 2:
Dates employed (mm/dd/yy):

from       to
Company Name and Address:

Supervisor Name:

     
Supervisor Contact Number:
Salary: $ start       $ end

Reason for Leaving:
May we contact? yes          
 

JOB 3:
Dates employed (mm/dd/yy):

from
      to
Company Name and Address:

Supervisor Name:

     
Supervisor Contact Number:
Salary: $ start       $ end

Reason for Leaving:
May we contact? yes          
Please indicate your available or preferred days: Monday            Tuesday    Wednesday       
Thursday          Friday        Saturday

        (Please check all that apply)
What hours are you available to work?
 7 - 12 am         12 - 5 pm      
5-10pm         other     
(Please check all that apply.)
If 'other', please describe:

Are you able to lift up to 40 pounds repeatedly?

 Yes        No      

Are you able to work in walk-in coolers?

Yes        No      

Do you speak English fluently?

 Yes        No      

List any other languages that you speak fluently:
At Harvest Co-op, our job is to move large amounts of food as quickly as possible, and provide exceptional customer service at the same time. What skills or abilities do you bring to the Co-op that will help us to accomplish this? ;
Why do you want to work at Harvest Co-op?

By checking the box at the end of this statement, you are submitting this form in place of an actual signature:

I certify, that to the best of my knowledge and belief, the answers and statements given by me to the foregoing questions or attached resume on this application are true and correct.
I understand that any misrepresentation or omission will be grounds for discharge from employment whenever discovered. I understand that if hired, my employment with Harvest Co-op Markets will be on an at-will basis.
I am free to resign or be terminated at any time.
Neither this application nor any other personnel forms constitute an employment contract.


I further authorize Harvest Co-op Markets to check and verify the information I certify, that to the best of my knowledge and belief, the answers and statements given by me to the foregoing questions or attached resume on this application are true and correct.
(agree)            (don't agree)