Job ApplicationQuestions or technical difficulties? Email us at: [email protected] "*" indicates required fieldsPersonal InformationName* First Last Current Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Cell Phone*Home PhoneGeneral InformationAre you 18 years of age or older?* Yes NoAre you legally authorized to work in the United States?* Yes NoAre you able to lift up to 50 pounds safely and regularly?* Yes NoAvailable Start Date* Month Day YearWhat types of employment will you accept?* Full Time (32+ hours/week) Part Time (20-32 hours/week) Any availableWhat Position(s) are you applying for?* Store Clerk Cashier Any AvailableSelect AllFor which shifts are you available?* Opening (7:30am-3:30pm) Midday (10am-6pm) Closing (2:30pm-8pm)Most positions require weekend scheduling. Are you available weekends?* Yes NoDo you have any scheduling restrictions?* Yes NoIf so, what days and times?Have you applied for a position at Placerville Food Co-op previously?* Yes NoIf so, when? Month Day YearHave you been employed by the Placerville Food Co-op previously?* Yes NoIf so, when? Month Day YearHow did you hear about this opportunity?*In StoreWebsiteFacebookIndeedEmployee ReferralOtherIf 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 HistoryPlease 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 NoEmployer NameCity and StateTitleResponsibilities and DutiesStart Date Month Day YearEnd Date Month Day YearReason for LeavingReason for LeavingTerminatedResignedPromotedLaid OffStill currently employedExplanationCompany PhoneDirect SupervisorOK to contact? Yes NoEmployer NameCity and StateTitleResponsibilities and DutiesStart Date Month Day YearEnd Date Month Day YearReason for LeavingReason for LeavingTerminatedPromotedResignedLaid offStill currently employedExplanationDirect SupervisorCompany PhoneOK to contact? Yes NoEmployer NameCity and StateTitleResponsibilities and DutiesStart Date Month Day YearEnd Date Month Day YearReason for LeavingReason for LeavingTerminatedPromotedResignedLaid OffStill currently employedExplanationDirect SupervisorCompany PhoneOK to contact? Yes NoSkills and ExperiencePlease 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 ExperienceProfessional ReferencesUse the (+) button to add at least 3 references.NameTitle/OccupationEmailPhone NumberHow do you know this reference? Add RemoveResume/Additional Employment History (multiple documents accepted) Drop files here or Select filesMax. 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 DutiesApplicant's StatementApplicant'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 CAPTCHA \n\n[/cs_content_seo][/cs_element_layout_column][/cs_element_layout_row][/cs_element_section][/cs_content]
