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Employment Opportunites

       EMPLOYMENT APPLICATION
      (PLEASE PRINT AND COMPLETELY ANSWER ALL QUESTIONS)
 
Our company (“Healthy Choices”) fully subscribes to the principles of Equal Employment Opportunity.  It is our policy to provide employment, compensation and other benefits related to employment based on qualifications, without regard to race, color, religion, national origin, age, sex, veteran status, genetic information, disability, or any other basis prohibited by federal, state, or local law.  In accordance with requirements of the Americans with Disabilities Act and applicable federal, state and/or local laws, it is our policy to provide reasonable accommodation upon request during their application process to applicants in order that they may be given a full and fair opportunity to be considered for employment.  As an Equal Opportunity Employer, we intend to comply fully with applicable feral, state and/or local employment laws and the information requested on this application will only be used to purposes consistent with those laws.  To the extent required by applicable law, Healthy Choices maintains a smoke-free workplace.
 
POSITION APPLIED FOR:____________________________________DATE:__________________
 
 
 
PERSONAL DATA
 
Salary expectations:__________________________
 
Name:______________________________________________________________________________
LastMiddle         First
 
Street Address:___________________________________________________________________
 
City:_________________________________State:______________________Zip Code:______________
 
Telephone:_______________________________Email:________________________________________
 
Are there any days, shifts or hours you will NOT work?       Yes      NO
 
If yes, please explain:____________________________________________________________________
 
Are you applying for full time or part time work?         Full Time      Part Time
 
Will you work overtime, if required?          Yes          No
 
NOTE:  It is not necessary for you to identify unavailability for work because of religious observance or practice or any other protected classification.  Subsequent to any job offer, we will consider whether a reasonable accommodation can be made. 
When will you be able to start work?___________________________
 
Were you referred by an employee?_______________________________
 
Have you ever applied or worked for Healthy Choices before?____________________
 
If yes, provide dates:____________________________________________________
 
Are you legally authorized to work in the United States?       Yes       No
 
 
Education
Describe any educational degrees, skills, training or experience you believe are relevant to the job applied for:
 
Name, City, and State of Educational Institution__________________________________________________________________________________
____________________________________________________________________________________________________________
 
         
Graduate:______________        
If no, Degree credits EarnedType of Degree Received or Expected
 
Major                                                                   
Minor              
Grade Point/Overall GPA
 
High School
 
College or University
 
Technical/GED
 
Licenses/Certification/Other
 
 
EMPLOYMENT HISTORY:
 
Please complete for all full-time or part-time employment beginning with most recent employer.  You may include as part of your employment history any verified work performed on a volunteer basis.  All applicants should start with their most recent job, include military assignments and voluntary employment.
 
 
 
Company Name:_____________________________Telephone:_________________________________
Address:______________________________________________________________________________
Name of Supervisor:________________________________May we contact:       Yes       No
 
Dates Employed: From:______To:_________ Rate of pay: Start:_______Last:_________
 
State job titles and describe job duties:_____________________________________________________
 
Reason for Leaving______________________________________________________________________
 
 
 
Company Name:_____________________________Telephone:_________________________________
Address:______________________________________________________________________________
Name of Supervisor:________________________________May we contact:       Yes       No
 
Dates Employed: From:______To:_________ Rate of pay: Start:_______Last:_________
 
State job titles and describe job duties:_____________________________________________________
 
Reason for Leaving______________________________________________________________________
 
 
Company Name:_____________________________Telephone:_________________________________
Address:______________________________________________________________________________
Name of Supervisor:________________________________May we contact:       Yes       No
 
Dates Employed: From:______To:_________ Rate of pay: Start:_______Last:_________
 
State job titles and describe job duties:_____________________________________________________
 
Reason for Leaving______________________________________________________________________
 
 
Company Name:_____________________________Telephone:_________________________________
Address:______________________________________________________________________________
Name of Supervisor:________________________________May we contact:       Yes       No
 
Dates Employed: From:______To:_________ Rate of pay: Start:_______Last:_________
 
State job titles and describe job duties:_____________________________________________________
 
Reason for Leaving______________________________________________________________________
 
 
Company Name:_____________________________Telephone:_________________________________
Address:______________________________________________________________________________
Name of Supervisor:________________________________May we contact:       Yes       No
 
Dates Employed: From:______To:_________ Rate of pay: Start:_______Last:_________
 
State job titles and describe job duties:_____________________________________________________
 
Reason for Leaving______________________________________________________________________
 
 
Have you ever been discharged or asked to resign from employment?____________
If yes, explain:_________________________________________________________________________
 
Did you receive any discipline in your last 12 months of active employment with your previous employer?___________If yes, explain:_____________________________________________________
 
Were you given a performance evaluation within the last 12 months of active employment?__________
If yes, what was the range of scores used and what was your score?______________________________ _____________________________________________________________________________________
 
Have you signed any non-competition or non-solicitation agreement or any other kind of agreement with any other employer that might restrict you from working for the company (you will be required to furnish a copy of the agreement if you are being considered for hire)?___________________________
If yes, please explain:___________________________________________________________________
 
 
PROFESSIONAL REFERENCES (Please list three individuals unrelated to you with whom you have worked who know your qualifications for this position.)
 
                       NAME            ADDRESS       PHONE       RELATIONSHIP
 
 
 
 
 
 
 
 
 
 
Healthy Choices, Inc. BBB Business Review