Hull Co-op Association - Non-Driver Application

APPLICATION FOR EMPLOYMENT

Hull Coop Association is an equal opportunity employer, dedicated to a policy of non‐discrimination in employment on any basis including race, creed, color, age, sex, religion, national origin, marital status, physical or mental handicap, or arrest record. This application will remain effective for a period of thirty (30) days or until the position is filled.

Notice: Pre‐Employment Substance and Alcohol testing is required.

APPLICATION FOR EMPLOYMENT

Notice: Pre‐Employment Substance and Alcohol testing is required.

Employment Interest

Current Date (m/d/yr.)

Date Available (m/d/yr.)

Position Desired

Minimum Salary Desired

What work schedule are you seeking?

Full-time

Part-time

Seasonal

Have you ever applied to work for this company before?

Yes

If yes, when?

How did you learn of this position?

Personal Information

Last Name:

First Name:

Middle Name:

Street Address:

City:

State:

Zip:

Home Phone:

Cell Phone:

Have you previously worked for this company?

Yes

If so, from:

To:

Reason for leaving:

Former supervisor(s) at this company:

Pertinent Information

Email Address

Are you 18 years old or older?

Yes

If hired, you will be required to furnish proof that you are legally authorized to work in the United States.

Are you able to perform the essential duties of the job(s) for which you are applying, as described, with or without reasonable accommodation?

Yes

Have you ever been convicted of a felony?

Yes

If yes, please explain, including the date(s):

*A “yes” answer will not automatically disqualify you from employment. We will consider the nature and date of the offense and the job for which you are applying for job‐related purposes only, and only to the extent permitted by applicable law.

Referred by:

State the name of any relative, other than a spouse, already employed by this company.

Employment Histroy

A resume may be emailed separately but will not be accepted in place of any information required on this form.

Employer:

Position Held:

Address:

Street:

City:

State:

Zip Code:

From (mm/yr.):

To (mm/yr.):

Duties:

Reason For Leaving:

Contact Person:

Phone Number:

May we contact:

Yes

Starting Salary:

Final Salary:

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Employer:

Position Held:

Address:

Street:

City:

State:

Zip Code:

From (mm/yr.):

To (mm/yr.):

Duties:

Reason For Leaving:

Contact Person:

Phone Number:

May we contact:

Yes

Starting Salary:

Final Salary:

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Employer:

Position Held:

Address:

Street:

City:

State:

Zip Code:

From (mm/yr.):

To (mm/yr.):

Duties:

Reason For Leaving:

Contact Person:

Phone Number:

May we contact:

Yes

Starting Salary:

Final Salary:

Education

High School

Name:

Location:

Did you Graduate?

Yes

Subjects Studies and Degree(s):

College

Name:

Location:

Did you Graduate?

Yes

Subjects Studies and Degree(s):

Trade, Business or Correspondence School

Name:

Location:

Did you Graduate?

Yes

Subjects Studies and Degree(s):

Other education or training:

Other special skills:

References

Please provide at least three professional references.

Name:

Company:

Title:

Phone:

Name:

Company:

Title:

Phone:

Name:

Company:

Title:

Phone:

Name:

Company:

Title:

Phone:

To Be Read And Signed By The Applicant

I certify that the answers given in this application are true and correct. I have not withheld any facts or circumstances. I authorize Hull Cooperative Association to make an investigation of my personal or employment history and authorize any present/former employer, person, firm, corporation, credit agency, or government agency to give Hull Cooperative Association any information they may have regarding me, and I understand that any misrepresentation or omission shall be cause for dismissal. In consideration of the prospective employer review of this application, I release Hull Cooperative Association and all providers of information from any liability as a result of furnishing and receiving this information.

I further agree that, if employed, I will conform my conduct to Hull Cooperative Association’s rules, regulations, and personnel policies. I understand that no personnel recruiter, interviewer, or other representative other than an officer of the company has the authority to enter into an agreement for employment for any specified period of time and that any employment manuals or handbooks that may be distributed to me during the course of my employment shall not be construed as a contract. I further understand that nothing contained in this application, or the granting of an interview creates a contract for either employment or providing any benefit, and THAT I HAVE THE RIGHT TO TERMINATE EMPLOYMENT AT ANYTIME AND THE COMPANY HAS THE SAME RIGHT.

Date:

Signature:

Required field

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