PT Food Co-op

Port Townsend Food Co-op, 414 Kearney St., Port Townsend, WA, 98368
Open Every Day 8am-9pm
Phone: (360) 385-2883

form test

Food Co-op Employment Application

Information about you

Your Name (required): [your-name]
Your Email (required): [your-email]
Address: [address]
Home Phone (required): [home-phone]
Work Phone: [work-phone]
Message Phone: [message-phone]
Date available to work: [date-available-to-work]
Are you applying for a specific position? [specific-position]
How did you learn about this position opening?
[learn-about-position]
Pay Requirements: [pay-requirements]
Number of hours per week you would prefer to work: [number-of-hours]
If hired, can you provide evidence of your legal right to work in the U.S.? [legal-right-work]
If you are under 18 years of age, can you provide proof of age and a work permit? [under-18]
If you are under 18, please state your age: [under-18-age]
Are you currently employed? [currently-employed]
Have you ever been discharged from any employment or asked to resign? [discharged-employment]
If “Yes” please explain (A “Yes” answer will not necessarily disqualify applicants from employment):
[discharged-resigned-employment]
Are you related to anyone who currently works at the Food Co-op? [related]
If “Yes” please indicate name(s) and position: [relative-name-position]
Have you been previously employed at the Food Co-op? [previously-employed]
If “Yes” list dates of employment and last position held: [date-previous-employment]

Background check required:

In the last 7 years, have you been convicted of a felony? [convicted-felony]
In the last 3 years, have you been convicted of a misdemeanor other than a minor traffic offense? [misdemeanor]
If “Yes”, please explain fully (“Yes” answers will not necessarily bar the applicant from employment): [explain-misdemeanor]

Employment History:

List in order beginning with present or most recent employer.
Employer #1: [employer-1]
Dates: [employer-1-date-start] to [employer-1-date-end]
Phone: [employer-1-phone]
City: [employer-1-city]
State: [employer-1-state]
Supervisor: [employer-1-supervisor]
Responsibilities: [employer-1-responsibilities]
Pay rate: [employer-1-pay-rate]
Reason for leaving: [employer-1-reason-for-leaving]
May we contact this employer? [employer-1-contact-employer]
Employer #2: [employer-2]
Dates: [employer-2-date-start] to [employer-2-date-end]
Phone: [employer-2-phone]
City: [employer-2-city]
State: [employer-2-state]
Supervisor: [employer-2-supervisor]
Responsibilities: [employer-2-responsibilities]
Pay rate: [employer-2-pay-rate]
Reason for leaving: [employer-2-reason-for-leaving]
May we contact this employer? [employer-2-contact-employer]
Employer #3: [employer-3]
Dates: [employer-3-date-start] to [employer-3-date-end]
Phone: [employer-3-phone]
City: [employer-3-city]
State: [employer-3-state]
Supervisor: [employer-3-supervisor]
Responsibilities: [employer-3-responsibilities]
Pay rate: [employer-3-pay-rate]
Reason for leaving: [employer-3-reason-for-leaving]
May we contact this employer? [employer-3-contact-employer]
Employer #4: [employer-4]
Dates: [employer-4-date-start] to [employer-4-date-end]
Phone: [employer-4-phone]
City: [employer-4-city]
State: [employer-4-state]
Supervisor: [employer-4-supervisor]
Responsibilities: [employer-4-responsibilities]
Pay rate: [employer-4-pay-rate]
Reason for leaving: [employer-4-reason-for-leaving]
May we contact this employer? [employer-4-contact-employer]
List periods of unemployment of more than 30 days and explain: [unemployment-periods]

Work References:

(Such as current or former supervisors/co-workers. Please do not list relatives)

Reference #1
Name: [reference-name-1]
Phone: [reference-1-phone]
Years known: [reference-1-years-known]
Reference #2
Name: [reference-name-2]
Phone: [reference-2-phone]
Years known: [reference-2-years-known]
Reference #3
Name: [reference-name-3]
Phone: [reference-3-phone]
Years known: [reference-3-years-known]

Education:

High School Name: [high-school-name]
Address: [high-school-address]
Graduated (or GED)? [high-school-graduated]
Degree: [high-school-degree]
College Name: [college1-name]
Address: [college1-address]
Graduated? [college1-graduated]
Degree: [college1-degree]
College Name: [college2-name]
Address: [college2-address]
Graduated? [college2-graduated]
Degree: [college2-degree]
Trade/Other: [other-name]
Address: [other-address]
Graduated? [other-graduated]
Degree: [other-degree]
Are you able to perform the essential duties of the job for which you are applying, with or without a reasonable accommodation? [essential-duties]
If no, please explain:[essential-duties-explain]
What skills and experience do you have in the following areas? Please state where and when you acquired skills and experience:
Cashiering: [cashiering]
Grocery cashiering: [grocery_cashiering]
Scanning Systems: [scanning-systems]
Retail Merchandising: [retail-merchandising]
Coops: [coops]
Produce: [produce]
Natural Foods: [natural-foods]
Grocery: [grocery]
Stocking: [stocking]
Food Service: [food-service]
Herbs Supplements: [herbs-supplements]
Cook: [cook]
Meat/Seafood Prep: [meat-seafood-prep]
Bookkeeping: [bookkeeping]
BusinessWorks Gold: [businessworks-gold]
List computer software programs you have used and level of proficiency:
[software]
Please describe any other knowledge, skills, abilities, education or experience which you feel would especially qualify you to work for the Food Co-op:
[skills]
How would working at the Co-op fit into your plans?
[plans]
What would you like us to know about you?
[about-you]
Work Availability
Please list day and times you ARE AVAILABLE to work at The Food Co-op.
Shifts are generally between the hours of 6:00 a.m. – 9:30 p.m.
[day-time-available]
[certify-true](yes) I certify that the information given by me to the Food Co-op is true and complete to the best of my knowledge. I understand that if I am employed, discovery that I gave false information during the application process may result in immediate termination of my employment.
[authorizie](yes) I authorize the Food Co-op to solicit information regarding my character, general reputation, criminal conviction history, previous employment and similar background information, and to contact any and all references I have given on my application. I hereby release all parties and persons connected with any such requests for information from all claims, liabilities and damages for any reason arising out of the furnishing of such information. If employed, I release the company from any liability for future references it may provide regarding my work history with the Food Co-op.
[agree-termination](yes) In consideration of my employment, I understand and agree that my employment can be terminated with or without cause, and with or without notice at any time, at the option of either the Food Co-op or myself. I understand that no representative of the Food Co-op other than the General Manager has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.

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