304 4TH STREET • LA PORTE CITY • IOWA

PHONE NUMBER: (319) 342-2754

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Thriftway Foods Application for Employment

An Equal Opportunity Employer

Each question should be fully and accurately answered. All information given will be available only to persons who have a "need to know" or as required by law. This company will make reasonable accommodation in the application process, if needed.

* indicates required field

General
Are you 18 or older?*
Are you legally eligible to work in the country where you wish to work?*
Would you be willing to consent to a background check or reasonable suspicion drug testing?* (Not applicable where prohibited by law)
Have you ever been convicted of a felony?* (A criminal record does not automatically bar employment)
Work Schedule/Availability
If offered a position, what is the earliest date you can start?*
$
Work preference:*
Are you willing to work a changing schedule?*
Are you willing to work extra days/shifts?*
Shift preference:*
Select which days of the week you are available to work:*
Were you referred by a current or former employee?*
Education
Select the highest grade you completed in high school/secondary school:*
Did you graduate?*
Employment History
Have you ever been terminated from a job or asked to resign?*

Employer 1

Are you still employed with this company?
May we contact this employer for a reference?
References

Reference 1

Relationship:
Years

All information provided by me is true and correct to the best of my knowledge. I understand any omissions or misrepresentations on this application may result in rejection or if employed, may be cause for subsequent dismissal. I hereby authorize any former employer, person, firm or corporation listed herein including this company to answer any and all question and agree to hold all persons harmless for giving any and all truthful information within their knowledge or records. I understand this is a preliminary application and not a contract to employ me. I understand and agree that any employment I may obtain is for no definite period of time. If employed, I agree to comply with all rules of the company as a condition of continued employment.

This Employment Application is used to notify me that the nature and scope of an investigation, if one is conducted, could include such general identification information as residence verification, and, as applicable, information concerning my employment, education, general reputation, character, personal characteristics, and habits, and that such information may be developed through personal interviews with third parties such as family members, neighbors, friends, associates, former employers, financial sources, and custodians of official records. Only job-related information developed from such a report will be considered in evaluating my employment application or continued employment. I hereby authorize these persons, companies, organizations or corporations to answer all questions or release any information regarding the items listed in this paragraph. I hereby release them from any liability and hold them harmless from any claim for releasing any truthful information within their knowledge and/or records.

I authorize the company to release to any person, firm, entity or organization with which I may seek employment in the future, any truthful information concerning my work experience with the company. I hereby release and hold the company harmless from any claim for releasing any truthful information within its knowledge and/or records.

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