What position are you applying to? *

Grocery Clerk

Other (please specify below)

Any position that becomes available

Name *

First Name

Last Name

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number *

(###)

###

####

Date of Birth *

MM

DD

YYYY

Are you looking for FT or PT? *

Full Time (32-40 hours/week)

Part Time (under 32 hours/week)

What days are you available to work? *

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

What time of day are you available to work? *

Mornings

Afternoons

Evenings

When are you available to start? *

MM

DD

YYYY

Job 1: Address of Employer

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Job 1: Phone Number of Employer

(###)

###

####

Job 1: Worked here from:

MM

DD

YYYY

until:

MM

DD

YYYY

Job 1: Name of Supervisor

First Name

Last Name

*

May we contact your previous supervisor as a reference?

Yes

No

Job 2: Address of Employer

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Job 2: Phone Number of Employer

(###)

###

####

Job 2: Worked here from:

MM

DD

YYYY

until:

MM

DD

YYYY

Job 2: Name of Supervisor

First Name

Last Name

*

May we contact your previous supervisor as a reference?

Yes

No

Job 3: Address of Employer

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Job 3: Phone Number of Employer

(###)

###

####

Job 3: Worked here from:

MM

DD

YYYY

until:

MM

DD

YYYY

Job 3: Name of Supervisor

First Name

Last Name

*

May we contact your previous supervisor as a reference?

Yes

No

We have a smoke-free working environment. Do you vape or smoke cigarettes, cigars, or pipe? *

Yes

No

Health/Natural Food *

Excellent

Good

Fair

Poor

Proper storage & selling of produce *

Excellent

Good

Fair

Poor

Vitamins & Minerals *

Excellent

Good

Fair

Poor

Herbal & Homeopathic Supplements/Topicals *

Excellent

Good

Fair

Poor

Natural Personal Care Products & Cosmetics *

Excellent

Good

Fair

Poor

Retailing *

Excellent

Good

Fair

Poor

Customer Service *

Excellent

Good

Fair

Poor

Retail Display & Effective Product Placement *

Excellent

Good

Fair

Poor

Cash Register Operations *

Excellent

Good

Fair

Poor

Excellent

Good

Fair

Poor

*

Reference 1 Name:

First Name

Last Name

*

Reference 1 Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

*

Reference 1 Phone Number:

(###)

###

####

*

Reference 2 Name:

First Name

Last Name

*

Reference 2 Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

*

Reference 2 Phone Number:

(###)

###

####

*

Reference 3 Name:

First Name

Last Name

*

Reference 3 Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

*

Reference 3 Phone Number:

(###)

###

####

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I certify that my answers are true and complete to the best of my knowledge. I understand that Mustard Seed Natural Market is an at-will employer. *

By selecting "yes", I understand I am placing my digital signature on this application which will hold me accountable to all information provided in this application.

Yes