Palace Application PALACE SUPERMARKET EMPLOYMENT APPLICATION We are an equal employment opportunity employer. We do not discriminate on the basis of race, color, creed, religion, ancestry, marital status, gender, gender identity, pregnancy, sex, sexual orientation, national origin, political affiliation, military status, age, or mental/physical disability, or any other protected status in accordance with applicable federal, state, and local laws. APPLICANT INFORMATIONLast Name* First* M.I. Date* Street Address* Apartment/Unit # City* State* ZIP* Phone* E-mail Address* Date Available Social Security No. Desired Salary Position Applied for Are you at least 18 years old?* Yes No Those hired under 18 will be required to obtain a work permit.Are you applying for:* Full Time Part Time Are you legally authorized to work in the United States?* Yes No Foreign languages spoken/writtenDo you have reliable transportation?* Yes No Have you ever worked for this company?* Yes No Have you ever been convicted of a felony?* Yes No If so, when? If yes, explainAre you able to perform the essential functions of the position for which you are applying either with or without reasonable accommodations? Yes No Availability Schedule:Sun Mon Tues Wed Thurs Fri Sat EDUCATIONHigh School Address Degree From MM slash DD slash YYYY To MM slash DD slash YYYY Did you graduate? Yes No College Address Degree From MM slash DD slash YYYY To MM slash DD slash YYYY Did you graduate? Yes No Other Address Degree From MM slash DD slash YYYY To MM slash DD slash YYYY Did you graduate? Yes No REFERENCES Please list two professional references.Full Name Relationship Company Phone Address Full Name Relationship Company Phone Address PREVIOUS EMPLOYMENTCompany Phone Address Supervisor Job Title Starting Salary $ Ending Salary $ Responsibilities From MM slash DD slash YYYY To MM slash DD slash YYYY Reason for Leaving May we contact your previous supervisor for a reference? First Choice Second Choice Company Phone Address Supervisor Job Title Starting Salary $ Ending Salary $ Responsibilities From MM slash DD slash YYYY To MM slash DD slash YYYY Reason for Leaving May we contact your previous supervisor for a reference? Yes No Have you ever been terminated or asked to resign from any job? Yes No If yes, please explain the circumstances:MILITARY SERVICEBranch From MM slash DD slash YYYY To MM slash DD slash YYYY Rank at Discharge Type of Discharge If other than honorable, explainDISCLAIMER AND SIGNATURE I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
