Employment Application Personal InformationNameAddressCity/State/ZipEmailVerify EmailPhoneTime most likely to be reached:9am-12pm12m-3pm3pm-6pmIf hired, can you show evidence of your right to work in the US?YesNoEmployment InformationPosition desiredCheck any area listed below in which you have skills or experience Cash Register Food service Produce Cooperatives Nutrition Customer Service For each item checked above, please state where and when you acquired these skills and experiencesDate you are available to start work Date Format: MM slash DD slash YYYY If there are any hours you can not work, what are they?Max number of hours a week you can workMinimum number of hours a week you can workHave you ever applied for work at the Co-op before?YesNoWhat are your pay requirements?Are there any other experiences or skills you feel would especially qualify you to work for the Co-op?Education and TrainingFirst SchoolSchool nameLocationYears completedDid you graduate?YesNoSecond SchoolSchool nameLocationYears completedDid you graduate?YesNoThird SchoolSchool nameLocationYears completedDid you graduate?YesNoFormer EmployersMost Recent EmployerEmployer name and phone numberEmployed from: Date Format: MM slash DD slash YYYY To: Date Format: MM slash DD slash YYYY Salary / WagePositionReason for leavingContact nameContact phoneNext EmployerEmployer name and phone numberEmployed from: Date Format: MM slash DD slash YYYY To: Date Format: MM slash DD slash YYYY Salary / WagePositionReason for leavingContact nameContact phoneNext EmployerEmployer name and phone numberEmployed from: Date Format: MM slash DD slash YYYY To: Date Format: MM slash DD slash YYYY Salary / WagePositionReason for leavingContact nameContact phoneNext EmployerEmployer name and phone numberEmployed from: Date Format: MM slash DD slash YYYY To: Date Format: MM slash DD slash YYYY Salary / WagePositionReason for leavingContact nameContact phoneReferencesFirst ReferenceNameJob TitlePhoneHow acquainted and for how longSecond ReferenceNameJob TitlePhoneHow acquainted and for how longProfile InformationHow would working at the Co-op fit into your future, career or personal plans?Are you a member of the Co-op?YesNoHow are you familiar with cooperative groceries and related products?Why do you wish to work at the Cook County Co-op?What does it mean to provide GREAT customer service as part of your job?I authorize my present and former employers (unless otherwise indicated on this application) to release to the co-op any information concerning my employment, including my job performance. Further, I release all these parties from liability for any damage, (except what resulting from misrepresentation,) which might result from furnishing this information. The information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I understand that falsified information or significant omissions may disqualify me from further consideration and may be considered satisfaction for dismissal if discovered at a later date. I understand that employment with the Co-op is for no definite period of time. Both the Co-op and its employees have, at all times, the right to terminate the employment relationship. E-Signature*Date* Date Format: MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged.
