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Adam's Hometown Market / Better Valu / Jerry's Employment Application
* Required
Applicant Information
Location(s) Applying to:
Adam's - Watertown
Adam's - White Hills
Better Valu - Cantebury
Better Valu - Lisbon
Better Valu - Plainfield
Jerry's - West Warwick
Adam's - Deep River
Adam's - Derby
Adam's - Milford
Adam's - Monson
Adam's - Terryville
Adam's - Thomaston
* First Name:    M. I.:    * Last Name:
* Street Address:    Apartment/Unit #
* City:    * State:    * Zip:
* Phone:    * Email:
* Date Available:    Desired Salary:
* Position Applied For: Part-Time:    Full-Time:   
Second Choice Position: Part-Time:    Full-Time:   
How did you hear about us?
Have you ever worked for this company?   YES    NO   
If so, when?  
Are you over the age of 18?   YES    NO   
Availability: List approximate times available next to each day. (ex. Monday: 3pm to 10pm)
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:
Education
High School:    Address:
From:    To:    Degree:
College:    Address:
From:    To:    Degree:
Other:    Address:
From:    To:    Degree:
References
1) Full Name:    Relationship:
Company:    Phone:
Address:
2) Full Name:    Relationship:
Company:    Phone:
Address:
3) Full Name:    Relationship:
Company:    Phone:
Address:
Previous Employment
1) Company:    Phone:
Address:    Supervisor:
Job Title:    Starting Salary $    Ending Salary $
Responsibilities:
From:    To:    Reason For Leaving:
2) Company:    Phone:
Address:    Supervisor:
Job Title:    Starting Salary $    Ending Salary $
Responsibilities:
From:    To:    Reason For Leaving:
3) Company:    Phone:
Address:    Supervisor:
Job Title:    Starting Salary $    Ending Salary $
Responsibilities:
From:    To:    Reason For Leaving:
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
* Signature (type name):    * Date: