Jobs Step 1 of 4 - Personal Information 25% Personal InformationName First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell PhoneEmail Address If you're under 18 years of age, please state your date of birth MM slash DD slash YYYY Are you interested in: (check all that apply) Full-Time Part-Time Date Available to start MM slash DD slash YYYY Position you are applying for EducationListType of School (High School, College, etc.)SchoolYear in SchoolGraduated? LegalAre you a U.S. citizen or do you have a legal right & necessary documents to work in the U.S.? Yes No Were you ever discharged by any company? Yes No If yes, give name of company(ies)Have you ever been convicted of a crime other than a minor traffic violation? Yes No (Note: you are not obligated to discuss sealed or expunged records of conviction or arrest nor will such information be asked of you or considered in employment decisions.) The existence of a criminal record will not automatically disqualify you from the job for which you are applying.If yes, please explain offense and final disposition Employment HistoryEmployer #1Employer Position Date Started MM slash DD slash YYYY Date Ended MM slash DD slash YYYY Starting SalaryFinal SalaryEmployer Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name of Supervisor Telephone Number of SupervisorMay We Contact? Yes No If no, please explainReason for LeavingEmployer #2Employer Position Date Started MM slash DD slash YYYY Date Ended MM slash DD slash YYYY Starting SalaryEnding SalaryEmployer Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name of Supervisor Telephone Number of SupervisorMay we Contact? Yes No if no, please explainReason for LeavingEmployer #3Employer Position Date Started MM slash DD slash YYYY Date Ended MM slash DD slash YYYY Starting SalaryEnding SalaryEmployer Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name of Supervisor Telephone Number of SupervisorMay we Contact? Yes No If no, please explainReason for Leaving PLEASE READ CAREFULLYIn the event of employment, I understand that false or misleading information given in my application or interview(s) may result in immediate dismissal. I understand, also, that I am required to abide by all rules and regulations of BET-R Neighborhood Market. I understand and agree that if employed, the employment will be "at will." That is, either I or BET-R Neighborhood Market may end the employment relationship at any time, for any reason, or for no reason. I understand that receipt of this application by BET-R Neighborhood Market does not imply employment and that this application and/or any other BET-R Neighborhood Market documents are not contracts of employment.* I certify by checking this box that I have read the above paragraph and that all information entered on my application is accurate. EmailThis field is for validation purposes and should be left unchanged. Δ
