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Online Application Form

About You
Your Name:
Your Address:
Your City, State, Zip:
Your Email Address:
Your Phone:
Date Available to Start:
Preferred Store Location:

About the Position
Desired Position:

Days and Hours your are available during the week:

Day	Mon.	Tues.	Wed.	Thurs.	Fri.	Sat.	Sun.
From:
To:

Willing to relocate? Yes No Willing to travel? Yes No

If you are under the age of 18, please state your birth

Were you referred by anyone at Save A Lot/Howard's IGA?
If so, whom?

Education - High School

Name:
Address:
City, State, Zip:
Degree:	Yes No

Education - College

Name:
Address:
City, State, Zip:
Degree:	Yes No
Degree or Area of Study :

Education - Graduate School

Name:
Address:
City, State, Zip:
Degree:	Yes No
Degree or Area of Study :

Other Education

Name:
Address:
City, State, Zip:
Degree:	Yes No
Degree or Area of Study :

U.S. Military

Branch of Service:
Technical Specialization:
Rank Attained:

Special Skills

Typing Speed (wpm):
Shorthand or Speedwriting (wpm):
Other Clerical Skills:
Computer Skills (type of skills):

Legal Information

Do you have a legal right & necessary documents to work in the U.S.
Yes No (Identity and employment eligibility of all new hires will be verified as required by the Immigration Reform and Control Act of 1986.)

Have you ever been convicted of a crime other than a minor traffic violation? Yes No. If yes, please explain offense and final disposition:

Employment History

Dates

Previous Employer

Salary / Wages

From:
To:

Job Title:

Supervisor:

Starting $:
Final $:

Duties:

Reason for leaving:

Dates

Previous Employer

Salary / Wages

From:
To:

Job Title:

Supervisor:

Starting $:
Final $:

Duties:

Reason for leaving:

Dates

Previous Employer

Salary / Wages

From:
To:

Job Title:

Supervisor:

Starting $:
Final $:

Duties:

Reason for leaving:

TO THE APPLICANT -
READ THIS STATEMENT CAREFULLY BEFORE SUBMITTING:

I agree to submit to a physical examination if required, offer being accepted for employment and if employed I further agree to abide by all rules and regulations of the Company. I certify that the answers to the foregoing questions on this application are true and correct to the best of my knowledge and belief and hereby authorize the investigation of all statements contained in this application which if found to be false will be
SUFFICIENT CAUSE FOR MY DISMISSAL.