Job Application Step 1 of 6 - Personal Information 16% Applicant InformationName* First Last Address* Street Address Address Line 2 City StateAlabamaAlaskaAmerican 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 Phone Number*Email Address* Employment PositionPosition Applying For*PositionAllCashierStockMeat DepartmentProduce DepartmentDeliBakeryMaintenanceManagementHow did you hear about this position?*What days are you available for work?*What hours or shift are you available for work?*Pay Expected per hour*If needed, are you available to work overtime?* Yes No Date Available to start MM slash DD slash YYYY Do you have reliable transportation to and from work?* Yes No Personal InformationHave you ever applied to or worked for Lamendola's Supermarket before?* Yes No If yes, when and why did you leave?Do you have any friends, relatives, or acquaintances working for Lamendola's Supermarket?* Yes No If yes, name(s) & relationship(s)Are you over 18 years old?* Yes No Will you consent to a mandatory controlled substance test?* Yes No Are you a U.S. citizen or do you have a legal right & necessary documents to work in the U.S.?* Yes No Do you have any condition, which would require job accommodations?* Yes No If yes, please describe accommodations required (Note: Lamendola's Supermarket complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional.)Have you ever been convicted of a crime other than a minor traffic violation?* Yes No If yes, please explain offense and final disposition(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) aplied for may, however, be considered.) Job Skills/QualificationsPlease list the skills and qualifications you possess for the position for which you are applying*EducationListType of School (High School, College, etc.)SchoolYear in SchoolGraduated?Degree Earned MilitaryAre you a member of the armed services?* Yes No In what branch of the military did you enlist?What was your military rank when discharged?How many years did you serve in the military?What military skills do you possess that would be an asset for this position? Previous EmploymentEmployer #1Employer NameEmployer PhoneEmployer 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 Job TitleName of SupervisorDates EmployedReason for LeavingEmployer #2EmployerEmployer PhoneEmployer 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 Job TitleName of SupervisorDates EmployedReason for LeavingEmployer #3EmployerEmployer PhoneEmployer 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 Job TitleName of SupervisorDates EmployedReason for Leaving ReferencesReference NameContact InformationReference NameContact InformationReference NameContact InformationAT Will Employment The relationship between you and Lamendola's Supermarket is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice by you or by Lamendola's Supermarket. No representative of Lamendola's Supermarket has authority to enter into any agreement contrary to the foregoing "at-will employment" relationship. You understand that your employment is "at-will" and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice President/ Chief Operations Officer or the company's President. By pressing "Submit", you are signing this form electronically, and agreeing with te above statement and acknowledging that all information given is true and accurate. Δ