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Chief Super Markets, Inc. is an equal employment opportunity employer. It is our policy to administer all of our employment practices, including those pertaining to recruitment, hiring, placement, transfer, promotion or compensation, layoff or termination, and selection for training in a nondiscriminatory manner without regard to age, color, gender/sex, sexual orientation, gender identity, national origin, disability/handicap, genetic information, race, religion, creed, or military/veteran status or on any other basis prohibited by federal, state, or local law. We endeavor to use the abilities of each Associate as fully as possible by taking into account experience, ability and personal interest. We also attempt to provide a working environment that is conducive to health, comfort and efficiency.

Position: Date of Application:
Location: Select all locations you would consider:
Email Address
Last Name First Middle  
       
Present Address      
Street City State ZIP
       
Telephone Number  
  Day Number Evening Number  
How did you hear about employment opportunities with our company?
Are you 18 years or older? Yes No If not, birth date?
Are you a U.S. Citizen?
Yes No
If not, do you have the legal right to work in the U.S.?
Yes No
Have you ever been convicted of a crime?
Yes No
If yes, explain ( a conviction will not necessarily disqualify you from employment)
Have you previously applied? Yes No or been interviewed in the last year? Yes No
Have you worked for a Chief/Rays company store before? Yes No If yes, when?
Location? Position held? Reason Left?
If you have worked for a Chief/Rays company store under another name, please state name.
         
EDUCATION Name and Location No. of Years Attended Did You Graduate?
Elementary  
     
High School  
     
College  
     
Other  
   
     
EMPLOYMENT HISTORY    
List all employers starting with present or most recent. Please fill this section out completely, in addition to any resume you may be attaching.
Are you currently employed?
Yes No		 Are you currently on layoff subject to recall?
Yes No		 May We Contact Your Present Employer?
Yes No
Dates of
Employment		 Employer Name
Your Job Title		 Address
Phone		 Hourly Rate Supervisor's Name & Title
Major Duties Performed		 Reason for
Leaving
From start
To
end
From start
To
end
From start
To
end
From start
To
end
Is this a complete list of your employment?
Yes No		 Have you ever been discharged from any position?
Yes No		 If yes, explain:

 REFERENCES
  Name Relationship Phone Number
1.
2.
3.
   
AVAILABILITY (We are open all hours, please indicate am or pm)
  MON TUES WED THURS FRI SAT SUN
FROM:
TO:
Type of Employment: Full Time Part Time Temporary  

SPECIAL SKILLS AND QUALIFICATIONS:
Summarize special skills and qualifications acquired from employment or other experience:		    
OTHER:
Why have you left, or are planning to leave your present job?		  
If hired, do you have reliable means of transportation to get to work? Yes No
Please indicate any further information which you feel would be of value to us in considering your application.
Date Available:
Read carefully before signing

  1. I have read and do understand the statements contained herein and certify that they are true, complete and accurate. If I have left a response blank, I have done so intentionally.
  2. I understand that false or incomplete statements on this application, in any resume or supporting documents, in the interview process or after employment commences are grounds for rejecting the application and for dismissal at any time after the statements are discovered no matter when the discovery occurs.
  3. I declare that I am legally entitled to work in the United States of America and will, prior to commencing employment, provide verification on a Form I-9.
  4. I authorize the company or any of its subsidiaries, agents, or employees to contact all previous employers, personal references and educational institutions in connection with my application for employment. I understand that the company's pre-employment investigation may also include a check of my criminal record, if any, and of the circumstances surrounding any conviction. I understand that any information gathered as a result of this investigation will be used solely for purposes of determining my fitness for employment. I consent to the investigation to be conducted and to the release to the company of the information specifically described in any separate consents and authorizations I have signed, which shall become a part hereof. In consideration of the company's review of my application, I agree to release and hold harmless the company, its subsidiaries, agents, and employees, and all previous employers and educational institutions, from any claimed liability arising from this investigation.
  5. In the event that I am employed by the company, or any of its subsidiaries, I agree to comply with and be governed by all its policies and procedures in effect at a given time, and I acknowledge that none of its policies and procedures constitute terms of employment contrary to paragraph 6 below.
  6. I acknowledge that this application is for employment of an indefinite duration, terminable at will and for any reason, either by me or by the company or any of its subsidiaries, except as otherwise provided by the terms of a collective bargaining agreement, if any, applicable to me.
  7. I understand that the terms of paragraph 6 cannot be altered except by a written agreement executed by an officer of the company or the subsidiary which employs me.
  8. I understand that, if hired, I may be required to work weekends.
  9. In consideration of the company's review of my application, I agree that any claim or lawsuit arising out of my employment with, or any application for employment with the company or any of its subsidiaries must be filed no more than six months after the date of the employment action that is the subject to the claim or lawsuit. While I understand that the statute of limitations for claims arising out of an employment action may be longer than six months, I agree to be bound by the six month period of limitations set forth herein, and I WAIVE ANY STATUTE OF LIMITATIONS TO THE CONTRARY. Should a court determine in some future lawsuit that this provision allows an unreasonably short period of time to commence a lawsuit, the court shall enforce this provision as far as possible and shall declare the lawsuit barred unless it was brought within the minimum reasonable time within which the suit should have been commenced.
  10. This application form supersedes any other application forms that I have previously submitted to the company. This application will be maintained only for 60 days. Any interest in becoming employed thereafter will require a new application.



Name Date
By providing your name in the above box, you are signing this document.

Chief does not hire individuals who are current users of illegal substances. By signing this application, you affirm that you do not now, and will not for the duration of your employment with Chief, use illegal drugs.

Name Date
By providing your name in the above box, you are signing this document.

If you want to attach a resume, plese choose the file below:

Revised 4/15/2010

 
   

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