PIGGLYWIGGLYALABAMADISTRIBUTINGCOMPANYINC.APPLICATION FOREMPLOYMENT

PERSONAL(PLEASE PRINTCLEARLY)

DATE:

NAME______

LASTFIRSTMI

PRESENTADDRESS

NO.STREETCITYSTATEZIP

HOWMANYYEARSHAVEYOU LIVEDATTHISADDRESS?TELEPHONENO.()

PREVIOUSADDRESS

NO.STREETCITYSTATEZIP

JOB(S)APPLIED FOR1.RATEOF PAY EXPECTED$PER

2.RATEOF PAY EXPECTED$PER

DOYOUWANTTO WORKFULLTIME, ORPARTTIME?SPECIFY DAYSHOURS IFPARTTIME:

HAVEYOUWORKED FORUS BEFORE?IFYES,WHEN?

LISTALLRELATIVESAND/OR CLOSE FRIENDS EMPLOYEDBYTHECOMPANY

IFHIRED, ONWHAT DATEWILLYOU BEAVAILABLETOSTARTWORK?DOYOU HAVEANY PRIORWORKEXPERIENCEWHICHYOUFEELWOULDHELPYOUIFYOUWEREHIREDBY THECOMPANY?

TYPEOFSCHOOL / NAMEANDADDRESS / YEARSATTENDED / GRADUATED? / COURSEORMAJOR
GRAMMERORGRADE
HIGH SCHOOL
COLLEGE
POSTGRADUATE
BUSINESS ORTRADE
OTHER

PERSONALREFERENCES:

NAMEANDOCCUPATION / ADDRESS / PHONENO.
1.
2.
3.

PRIORWORKHISTORY(LISTIN ORDER,LAST OR PRESENTEMPLOYERFIRST. USEADDITIONALPAPER IFNECESSARY):

DATES / NAMEANDADDRESSOFEMPLOYER / RATEOF PAY / SUPERVISOR’SNAME
TITLE / REASONFORLEAVING
FROM / TO / START / FINISH / PHONE()-
DESCRIBE INDETAILTHEWORK THAT YOUPERFORMED:
MAYWECONTACT THISEMPLOYER?YESNO
DATES / NAMEANDADDRESSOFEMPLOYER / RATEOF PAY / SUPERVISOR’SNAME
TITLE / REASONFORLEAVING
FROM / TO / START / FINISH / PHONE()-
DESCRIBE INDETAILTHEWORK THAT YOU PERFORMED:
MAYWECONTACT THISEMPLOYER?YESNO
DATES / NAMEANDADDRESSOFEMPLOYER / RATEOF PAY / SUPERVISOR’SNAME
TITLE / REASONFORLEAVING
FROM / TO / START / FINISH / PHONE()-
DESCRIBE INDETAILTHEWORK THAT YOU PERFORMED:
MAYWECONTACT THISEMPLOYER?YESNO

UNEMPLOYMENT RECORD

YOU MUSTACCOUNT FORALLPERIODS OF UNERMPLOYMENT IN THELAST FIVE(5)YEARS.LISTALLLOSTTIME INEXCESSOF30DAYS.

FROM / TO / REASON

IUNDERSTANDTHAT THISISAN APPLICATIONAND NOTACONTRACTORUNILATERALOFFERTOENTERINTOACONTRACTOF ANYKINDBETWEENTHEUNDERSIGNEDANDTHEEMPLOYER.THEUSEOFTHISAPPLICATIONFORMDOESNOTINDICATETHATTHEREAREANYPOSITIONS OPENANDDOESNOTINANY WAY OBLIGATETHIS EMPLOYER.

IUNDERSTANDTHATEPLOYMENTISCONDITIONALUPON,ANDIAUTHORIZEYOUTOMAKESUCHINVESTIGATIONSANDINQUIREOFMYPERSONAL,EMPLOYMENT,FINANCIALANDOTHERLEGALLYRELATEDMATTERSASMAYBENECESSARYINARRIVINGATANEMPLOYMENTDECISION.I HEREBYRELEASE EMPLOYERS,SCHOOLS, ORPERSONS FROMANYANDALL LIABILITIES INRESPONDING TOINQUIRIES IN CONEECTIONWITHMY APPLICATION.

I HEREBYCERTIFYTHATALLOF THEINFORMATIONIHAVE GIVENONTHIS APPLICATIONISTRUEAND COMPLETE,ANDTHAT THEREARENOFALSESTATEMENTSOROMISSIONSCONTAINEDINMYRESPONSETOTHEQUESTIONSINTHISAPPLICATION.IUNDERSTANDTHATANYFALSEINFORMATIONOROMMISSIONS,WHETHERMADEOROMITTEDINTENTIONALLYORWRITTENANDLATERDISCOVERED,MAYBECAUSEFORREFUSALTO HIREMEORFORIMMEDIATEDISMISSALWITHOUTFURTHERNOTICE.

THISAPPLICATIONISCURRENTFORONLYSIXTY(60)DAYS.ATTHECONCLUSIONOFTHISTIME,IFIHAVENOTHEARDFROMTHEEMPLOYERANDSTILL WISHTOBECONSIDEREDFOREMPLOYMENT,ITWILLBENECESSARYFORMETOFILLOUTANEWAPPLICATION.

DATESIGNATUREOFAPPLICANT