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D`Agostino Employment Application

An Equal Opportunity Employer

 

Date 7/5/2008

 

Personal Information

First Name*

Last Name*

Phone*

Email*

Street Address*

Apartment

City*

State, Zip*

  

 
 

Personal Questions

Question 1*

  Yes    No

Are you 18 years of age or older?

 

Question 2

  Yes    No

Were you referred to us by someone?

 

Question 3*

  Yes    No

Are you employed now?

 

Question 4

  Yes    No

Have you been previously employed by D`Agostino?

 

Question 5*

  Yes    No

Have you ever been convicted of a crime?

 
 

Work Amount Desired

 

Full Time  Part Time

 
 

Position Desired

Position Desired

 

Location Desired

Location Desired

 

Availability

Available to Start

Weekday

Specific Times

 Monday

 Tuesday

 Wednesday

 Thursday

 Friday

 Saturday

 Sunday

 

Wage Desired

Wage Desired

Wage Per

 
 

Education: Schools, Colleges & Other Training (List In Order Of Completion)

High School

  

Name  Years Complete

 Graduated/Completed  Yes  No  Attending

 

College

  

Name  Years Complete

 Graduated/Completed  Yes  No  Attending

 

Other 1

  

Name  Years Complete

 Graduated/Completed  Yes  No  Attending

 
 

Employment History (List Most Recent First)

Employer 1

  

Employer

Last Position

Supervisor

Street Address

City

State  Zip

Phone

Ending Pay

Employed From To Reason For Leaving   

Duties & Responsibilities

 

Employer 2

  

Employer

Last Position

Supervisor

Street Address

City

State  Zip

Phone

Ending Pay

Employed From To Reason For Leaving   

Duties & Responsibilities

 

Employer 3

  

Employer

Last Position

Supervisor

Street Address

City

State  Zip

Phone

Ending Pay

Employed From To Reason For Leaving   

Duties & Responsibilities

 
 

Personal or Business References (List Most Recent First)

Reference 1

  

Name

Company

Position

Street Address

City

State  Zip

Phone

   

I know this person as a
Supervisor    Co-Worker    Friend    Other

 

Reference 2

  

Name

Company

Position

Street Address

City

State  Zip

Phone

   

I know this person as a
Supervisor    Co-Worker    Friend    Other

 
 

Policy & Application Agreement

 

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 understand and agree that D'Agostino Supermarkets ("D'Agostino") will verify all or part of the information I have given my prospective employer. I hereby authorize D'Agostino to procure a consumer report and/or an investigative consumer report on me, and make any inquiry into my credit history, motor vehicle driving record, criminal and civil records, prior employment (including contacting previous employers), education (including degree, GPA and attendance) as well as other public record information. I understand that an investigative consumer report commonly includes information concerning character, general reputation, personal characteristics or mode of living. That information may be obtained through personal interviews with my neighbors, friends, associates, or others with whom I am acquainted. If I am granted employment, I further authorize my prospective employer to subsequently, from time to time, request consumer reports, other than investigative consumer reports, in connection with my employment. I release and hold harmless from all liability any individual or entity requesting or supplying information with respect to my application for employment. I understand upon written request to my prospective employer, I will be informed whether an investigative consumer report was requested, and be given complete and accurate disclosure as to the nature and scope of the investigation requested.

 I Agree   I Do Not Agree *

 
 

Submit Your Application

 

You can submit your completed application to us electronically by clicking the Submit Button below, or if you prefer you can click the Print Button to view a printer friendly version of your completed application.