APPLY – Dearborn Fresh Supermarket

Programs, services and employment are equally available to everyone. Please let us know if you need a reasonable accommodation for the application or interview.

Type of employment desired

Full-TimePart-TimeTemporarySeasonal

Date available to start

Desired pay (optional)

Which shifts can you work?

MorningAfternoonEvening / Night

Please specify

First name

Last name

Street address

City

State

ZIP code

Mobile phone

Other phone (optional)

Email (optional)

Are you 18 years of age or older?

YesNo

If you are under 18, can you provide a work permit?

YesNo

If no, please explain

Have you ever worked for Dearborn Fresh Supermarket?

YesNo

If yes, when?

Are you legally authorized to work in the United States?

YesNo

Have you ever pleaded guilty, no contest, or been convicted of a crime?

YesNo

Answering yes does not mean automatic rejection. The date of the offense, its seriousness and nature, rehabilitation, and the position applied for will be considered.

If yes, give dates and details

Do you have a valid driver’s license? (optional)

YesNo

Start with your most recent job.

I don’t have previous work experience (this would be my first job)

Which languages do you speak?

EnglishArabicSpanishOther

Other language(s)

Summarize any special skills or qualifications (optional)

Please check your answers before signing.

I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial and other related matters as may be necessary for an employment decision. I hereby release employers, schools or individuals from all liability when responding to inquiries in connection with my application.

In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.

I have read and agree to the statement above *

Type your full name

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Date:

Employment Application

Job

Thank you!