Name: *

First Name

Last Name

Application Date: *

MM

DD

YYYY

Address: *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Preferred Phone #1:

(###)

###

####

Preferred Phone #2:

(###)

###

####

If you are under 18 years of age, please state date of birth:

MM

DD

YYYY

Location:

East Store

West Store

Howard Store

Dig & Save Outlet

Any

Which type of employment are you seeking?

Part-time

Full-time

Either

If required for the position, do you have a valid driver's license?

Yes

No

Have you ever been convicted or plead guilty or no contest to a misdemeanor or felony or other offense or civil forfeiture?

(NOTE: A conviction is not an automatic bar to employment except as it may substantially relate to the job to which you are applying.)

Yes

No

Are you currently attending school?

Yes

No

Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone #:

(###)

###

####

Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone #:

(###)

###

####

Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone #:

(###)

###

####

Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone #:

(###)

###

####