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Personal Information

* Indicates required field

Name *

First

Last

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Are you 18 Years of age or older *

No Yes

Who were you referred by? *

Have you ever been employed by this Company before *

No Yes

If yes, What Location? *

Reason for leaving? *

Are you eligible to lawfully become employed in the United States? *

Yes No

Employment Desired

What Position are you applying for? *

Employment Desired *

Date You Can Start *

Pay Rate Desired *

Hours you are Available to work (list each day)

Sunday----- (Start) *

Sunday----- (End) *

Monday---- (Start) *

Monday------ (End) *

Tuesday--- (Start) *

Tuesday----- (End) *

Wednesday (Start) *

Wednesday (End) *

Thursday (Start) *

Thursday----- (End) *

Friday----- (Start) *

Friday----- (End) *

Saturday (Start) *

Saturday--- (End) *

Education

High School

College

Trade, Business or Correspondence School

Name and Location HS *

Name and Location C *

Name and Location TS *

No. of Years Attended HS *

No. of years attended C *

No. of years attended TS *

Did you Graduate? HS *

Did you Graduate? C *

Did you Graduate? TS *

Subjects Studied HS *

Subjects Studied C *

Subjects Studied TS *

General
Other skills, Certifications, Abilities:

Please list skills below *

U.S. Military or Naval Service *

Rank *

Present Membership in National Guard or Reserves *

Former Employers
List below employers for the last 10 years.

Employer 1

Name and Address of Employer *

Dates Employed From- To (MM/YY - MM/YY) *

Pay Rate *

Titles/Duties *

Reason for leaving *

Employer 2

Name and Address of Employer *

Dates Employed From-To (MM/YY - MM/YY) *

Pay Rate *

Titles/Duties *

Reason for leaving *

Employer 3

Name and Address of Employer *

Dates Employed From-To (MM/YY - MM/YY) *

Pay Rate *

Titles/Duties *

Reason for leaving *

Employer 4

Name and Address of Employer *

Dates Employed From-To (MM/YY -MM/YY) *

Pay Rate *

Titles/Duties *

Reason for leaving *

Employer 5

Name and Address of Employer *

Dates Employed From-To (MM/YY -MM/YY) *

Pay Rate *

Titles/Duties *

Reason for leaving *

Why would you like to work at Save A Lot *

References

Give the names of three people not related to you, whom have known you at least 1 year.

Reference 1

Name (First/Last) *

Phone Number *

Address *

Business *

No. of Years Acquainted *

Reference 2

Name (First/Last) *

Phone Number *

Address *

Business *

No. of Years Acquainted *

Reference 3

Name (First/Last) *

Phone Number *

Address *

Business *

No. of Years Acquainted *

Application Acknowledgment

Please read the following statements carefully, then acknowledge that you have read and approved it by providing the information requested at the bottom of the form.

I affirm that all the information I have supplied on this application and on all of the documents and information submitted by me or on my behalf is accurate and complete. I understand and accept that any omissions, distortions, or misinformation as determined by the Company are grounds for immediate dismissal from consideration for employment or termination of employment if I am hired. . I understand that nothing in this application is intended to imply or create a contract of employment between the Company and myself. I understand that, if hired, my employment is at-will and can be terminated at any time for any reason, by the Company or myself, with or without notice.

By electronically signing below, I certify that I have read, fully understand, and accept all terms of the foregoing statement.

Electronic Signature *

Date *

Thank You for applying at Save A Lot! Save A Lot is an equal opportunity employer.

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