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Get Fareway Stores Employment application

DURING THE APPLICATION PROCESS AND ANY TIME THROUGHOUT MY EMPLOYMENT I AUTHORIZE FAREWAY STORES INC. 2300 E. 8th Street Boone IA 50036-0070 515-432-2623 www. fareway. com PERSONAL Full Name Please print First Middle Initial Last E-Mail Street City State Current Address Number Telephone Cell Zip Social Security Number Are you 18 years of age or older Yes No Are you legally able to work in the United States Have you ever been known by any other name s that this company will require to verify any of the information on this application If Yes please list name s EMPLOYMENT DESIRED Job Title Are you available for work Date you can start Full-Time Wage Desired Part-Time Shift-Work Seasonal EDUCATION Do you have a High School Diploma or GED Name of last school attended Circle last year of school completed Circle the highest degree earned High School Diploma GED Certificate AA BD MD PHD Other Area of Concentration and/or degree s certificates licenses endorsements other training or skills PERSONAL REFERENCES List three people who have known you at least four years. Do not list relatives. Complete Address Phone Years Known EMPLOYMENT HISTORY Former Employment List employers starting with the current or most recent. Explain all gaps in time of employment Company Name Address Start Date / End Date Rate of Pay Detailed Job Duties Reason for Leaving May we contact your former employers to verify this information The law prohibits discrimination in hiring due to age race color creed sex national origin religion disability or veteran s status. Please provide any additional information about your abilities or interests that makes you a good candidate for this position I CERTIFY I HAVE READ AND FULLY COMPLETED BOTH SIDES OF THIS APPLICATION AND THE INFORMATION CONTAINED HEREIN IS CORRECT TO THE BEST OF MY KNOWLEDGE* I UNDERSTAND ANY OMISSION OR FALSE INFORMATION IS GROUNDS FOR TERMINATION OF EMPLOYMENT. I FURTHER UNDERSTAND MY EMPLOYMENT MAY BE CONTINGENT UPON SUCCESSFUL COMPLETION OF A BACKGROUND CHECK. TO OBTAIN INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT UNLESS OTHERWISE INDICATED ABOVE AND ALL OTHER PERTINENT INFORMATION PERSONAL OR OTHERWISE* Signature Date. Do not list relatives. Complete Address Phone Years Known EMPLOYMENT HISTORY Former Employment List employers starting with the current or most recent. Explain all gaps in time of employment Company Name Address Start Date / End Date Rate of Pay Detailed Job Duties Reason for Leaving May we contact your former employers to verify this information The law prohibits discrimination in hiring due to age race color creed sex national origin religion disability or veteran s status. Explain all gaps in time of employment Company Name Address Start Date / End Date Rate of Pay Detailed Job Duties Reason for Leaving May we contact your former employers to verify this information The law prohibits discrimination in hiring due to age race color creed sex national origin religion disability or veteran s status. Please provide any additional information about your abilities or interests that makes you a good candidate for this position I CERTIFY I HAVE READ AND FULLY COMPLETED BOTH SIDES OF THIS APPLICATION AND THE INFORMATION CONTAINED HEREIN IS CORRECT TO THE BEST OF MY KNOWLEDGE* I UNDERSTAND ANY OMISSION OR FALSE INFORMATION IS GROUNDS FOR TERMINATION OF EMPLOYMENT. .

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