Job Application - Placerville Food Co-op

Personal Information

Name*

First Last

Current Address*

Street Address Address Line 2 City State ZIP Code

Email*

Cell Phone*

Home Phone

General Information

Are you 18 years of age or older?*

Yes

Are you legally authorized to work in the United States?*

Yes

Are you able to lift up to 50 pounds safely and regularly?*

Yes

Available Start Date*

Month

Day

Year

What types of employment will you accept?*

Full Time (32+ hours/week)

Part Time (20-32 hours/week)

Any available

What Position(s) are you applying for?*

Store Clerk

Cashier

Produce Clerk

Deli Clerk

Any Available

For which shifts are you available?*

Opening (7:30am-3:30pm)

Midday (10am-6pm)

Closing (2:30pm-8:15pm)

Most positions require weekend scheduling. Are you available weekends?*

Yes

Do you have any scheduling restrictions?*

Yes

If so, what days and times?

Have you applied for a position at Placerville Food Co-op previously?*

Yes

If so, when?

Month

Day

Year

Have you been employed by the Placerville Food Co-op previously?*

Yes

If so, when?

Month

Day

Year

How did you hear about this opportunity?*

If you answered 'Employee Referral' or 'Other' to the previous question, please give employee name or source.

Why are you interested in a position at Placerville Food Co-op?

Employment History

Please provide the following requested information regarding your employment history: Include military service assignments and volunteer activities. You may exclude organization names that include race, color, religion, gender, national origin, ancestry, age, disability or other protected status.

Are you currently employed?*

Yes

Current or Most Recent Employer

Employer Name

City and State

Title

Responsibilities and Duties

Start Date

Month

Day

Year

End Date

Month

Day

Year

Reason for Leaving

Explanation

Company Phone

Direct Supervisor

OK to contact?

Yes

2nd Previous Employer

Employer Name

City and State

Title

Responsibilities and Duties

Start Date

Month

Day

Year

End Date

Month

Day

Year

Reason for Leaving

Explanation

Direct Supervisor

Company Phone

OK to contact?

Yes

3rd Previous Employer

Employer Name

City and State

Title

Responsibilities and Duties

Start Date

Month

Day

Year

End Date

Month

Day

Year

Reason for Leaving

Explanation

Direct Supervisor

Company Phone

OK to contact?

Yes

Skills and Experience

Please check the box(es) of any skills/experiences/certifications that you have already obtained:

Cash handling experience

Cashiering

Knife skills

Produce experience

Retail experience

ServeSafe/Food Handler's Certification

Food handling experience (deli, prep kitchen, etc.)

Do you have any other skills/experiences/certifications that you feel would benefit the Co-op?

Related Volunteer Experience

Professional References

Use the (+) button to add at least 3 references.

Name

Title/Occupation

Phone Number

How do you know this reference?

Resume/Additional Employment History (multiple documents accepted)

Drop files here or

Max. file size: 5 MB.

Submit a resume, be sure it includes an employment history with the following: Employer Name, Employer City, Employer State, Employer Country, Employer Contact Phone, Supervisor Name, Your Last Position, Employment Start and End Dates and Job Duties

Applicant's Statement

Applicant's Statement*

Placerville Food Co-op is an equal opportunity employer. Our customers come from all walks of life, and we want our team to reflect that. All qualified applicants will receive consideration for employment without regard to age, race, color, ancestry, national origin, religion, sex, gender identity, gender expression, sexual orientation, disability, protected veteran status, or any other protected characteristic. We will provide accommodations during the application process upon request.

I certify that the information on this application is true, complete and correct. I hereby authorize the investigation of my past employment, education and activities and I release from all liability all persons, companies and corporations supplying such information. I understand that false answers, statements or significant omissions made by me on this form shall be sufficient cause for denial of employment or discharge.

I have read and agree to this disclaimer.

Applicant Signature*

Date*

MM slash DD slash YYYY

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