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 Contents

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Kuhn's Markets considers all qualified applicants without regard to Race, Color, Religion, National Origin, Sex, Age, Disability, Disabled Veterans or Veterans from the Vietnam Era.

PLEASE READ CAREFULLY * ANSWER ALL QUESTIONS

General Information

Last Name: First Name: MI:

Street Address 1:

Street Address 2:

City: State: Zip Code:

Phone: Social Security #:

Under 18? Yes No    Referred By:

Position Applying For: Earnings Expected:

Available To Work: Full Time Part Time Days Evenings Other

Are you a United States Citizen or an alien authorized to work in the United States? Yes No

Have you ever been employed with Kuhn's Markets before? Yes No

If yes, what location? Dates of employment from to

Reason for leaving

Have you ever been convicted of a felony and/or of any crime involving dishonesty, which has not been expunged? Yes No

If yes, (A conviction will not necessarily be a bar to employment; factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account) please explain in detail:

Have you served in the United States Armed Forces? Yes No

Dates of Service from to Branch of Service:

Rank when discharged: Reserve Status:

Personal References

Name of Reference

Address of Reference

Telephone Number

Employment History

The following work experience section must be completed even if accompanied by a resume.  You may also include any verified work that was performed on a voluntary basis.

List most current first

Present Employer:

Address:

Position Held:

Starting rate of pay: Ending rate of pay:

Dates of employment from to   Part Time Full Time

May we contact this employer? Yes No

Supervisors Name: Phone Number:

Reason for leaving:

Previous Employer:

Address:

Position Held:

Starting rate of pay: Ending rate of pay:

Dates of employment from to   Part Time Full Time

May we contact this employer? Yes No

Supervisors Name: Phone Number:

Reason for leaving:

Previous Employer:

Address:

Position Held:

Starting rate of pay: Ending rate of pay:

Dates of employment from to   Part Time Full Time

May we contact this employer? Yes No

Supervisors Name: Phone Number:

Reason for leaving:

Previous Employer:

Address:

Position Held:

Starting rate of pay: Ending rate of pay:

Dates of employment from to   Part Time Full Time

May we contact this employer? Yes No

Supervisors Name: Phone Number:

Reason for leaving:

Educational Data

School Name

City & State

Degree or Grade Level Completed

List other skills that would be helpful to us in considering your application for employment.

General Information

To the extent permitted by law, are you willing to submit to testing for illegal
drug/alcohol detection? Yes No

Have you ever been reprimanded, counseled or terminated
for absenteeism or tardiness? Yes No

If yes, please explain:

How did you learn of this job?

Referred by:

Miscellaneous

Why do you want to work for Kuhn's Markets?

Authorization: Read Carefully

*Note: Submitting the following application assumes the applicant has read the authorization statement and agrees to the stated terms. 

© 2001 - 2002 Quality Foods Corp.
Intended for employment at Kuhn's Markets

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