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Klein`s Family Market Employment Application

An Equal Opportunity Employer

 

Date 8/28/2008

 

Personal Information

First Name*

Last Name*

Phone*

Email*

Street Address*

Apartment

City*

State, Zip*

  

 
 

Personal Questions

Question 1*

  Yes    No

Have you ever been employed by us before?

 

Question 2

  Yes    No

Are you able to perform the essential functions of the job with or without reasonable accommodations?

 

Question 3*

  Yes    No

Do you currently have any relatives working for us?

 

Question 4*

  Yes    No

During the last seven years, have you ever been convicted of a crime? (NOTE: You may omit information regarding convictions which have been expunged. A conviction will not necessarily disqualify any applicants.)

 
 

Position Desired

Position Desired

 

Location Desired

Location Desired

 

Availability

Available to Start

Weekday

Specific Times

 Monday

 Tuesday

 Wednesday

 Thursday

 Friday

 Saturday

 Sunday

 
 

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

 

Reference 3

  

Name

Company

Position

Street Address

City

State  Zip

Phone

   

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

 
 

Special Skills & Qualifications

Other Special Training or Skills (machine operation, professional licenses, etc.)

 
 

Policy & Application Agreement

 

I authorize the investigation of all statements contained in this application. I understand that the misstatement or omission of facts called for in this application will result in my immediate dismissal. Further, I understand and agree that my employment is "at will" and for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time with or without cause or notice at the option of either Klein's or myself. Further, I understand that no officer, agent, representative or employee of Klein's has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to that contained in the previous sentence. I also authorize Klein's to deduct from my wages any amounts which may be due as a result of overpayment of wages, loss or destruction of its property or any amounts which I may lawfully owe Klein's, or for which I have received full consideration. In the event I become an employee of Klein's, I agree with all rules and regulations and understand I may be terminated or disciplined for any reason.

I acknowledge and agree to the following: UNDER MARYLAND LAW AN EMPLOYER MAY NOT REQUIRE OR DEMAND ANY APPLICANT FOR EMPLOYMENT OR PROSPECTIVE EMPLOYMENT OR ANY EMPLOYEE TO SUBMIT TO OR TAKE A POLYGRAPH, LIE DETECTOR OR SIMILAR TEST OR EXAMINATION AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. ANY EMPLOYER WHO VIOLATES THIS PROVISION IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT TO EXCEED $100.

 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.