Fillable Printable Houchens Industries Application for Employment Form

Houchens Industries Application for Employment Form

PERSONAL

Last Name First Middle Date

Street Address Home Telephone

City, State, Zip Business Telephone

Have you ever applied for employment with us?

Yes No

If yes, Month and Year Location

Position Desired Pay Expected

Are you available for full-time work? Will you work overtime if asked?

Yes No

If not, what hours can you work?

Are you legally eligible for employment in the United States? When will you be available to

begin work?

Other special training or skills (languages, machine operations, etc.)

HOUCHENS INDUSTRIES, INC.

APPLICATION FOR EMPLOYMENT

MEMBERSHIP IN PROFESSIONAL OR CIVIC ORGANIZATIONS

(Optional)

Houchens Industries, Inc. is an Equal Opportunity Employer. Houchens Industries, Inc. does not

discriminate on the basis of race, color, national origin, religion, sex, age, disability or military status.

EDUCATION

School

Graduate

College

Business/Trade

Technical

High School

Elementary

Name & Location of School

Course of

Study

No. of Years

Completed

Did You

Graduate

Degree or

Diploma

Yes No

EMPLOYMENT

Company Name Telephone

Address Employed-(State month and year)

From: To:

Name of Supervisor Weekly Pay

State Job Title and Describe Your Work Reason for Leaving

Company Name Telephone

Address Employed-(State month and year)

From: To:

Name of Supervisor Weekly Pay

State Job Title and Describe Your Work Reason for Leaving

Company Name Telephone

Address Employed-(State month and year)

From: To:

Name of Supervisor Weekly Pay

State Job Title and Describe Your Work Reason for Leaving

Company Name Telephone

Address Employed-(State month and year)

From: To:

Name of Supervisor Weekly Pay

State Job Title and Describe Your Work Reason for Leaving

Did you serve in the Armed Forces? If “Yes” what Branch?

Yes No

MILITARY

OTHER INFORMATION

Are you over 18 years of age?

Yes No

If not, employment is subject to age verification.

Have you been convicted of a crime in the past ten years? Yes No

If “Yes” describe in full. (A conviction record will not necessarily be a bar to employment)

What was your previous address? How long at your present address? _________

How long at your previous address? ________

The information provided in this Application for Employment is true,

correct, and complete. If employed, any misstatement or omission of fact

on this Application for Employment may result in my dismissal.

I authorize Houchens Industries, Inc. and its agents to conduct a

background investigation of my personal, employment, criminal, and credit/

ﬁnancial histories as well as other matters in arriving at an employment

decision. I hereby release former employers, educational institutions,

law enforcement agencies, credit agencies and all other persons or legal

entities from any and all liability in responding to inquiries during the

investigation of my background and further release Houchens Industries,

Inc. from any and all liability in connection with the investigation of my

background.

If employed, I agree to comply with all policies, procedures and

conditions of Houchens Industries, Inc. relating to my employment. I

understand that my employment can be terminated at any time, with

without cause, at the discretion of either Houchens Industries, Inc. or me.

I further understand and agree that the development and dissemination

of policies, procedures, handbooks or other literature by Houchens

Industries, Inc. does not and will not in the future constitute or establish a

contractual or other obligation to continue my employment.

Date Signature

Have you ever been previously employed by Houchens Industries, Inc. which owns and operates Houchens Markets, Jr. Food Stores, Save-A-Lot

Stores, Stewart & Richey Construction, Southern Recycling, Center of Insurance, Foodland, Piggly Wiggly, Adams and Sullivan, Buehlers Buy Low,

Scot Mkts, Shell and Pan Osten. Sonic Drive-In, Whites Fresh Foods, Subway, Scotty’s, IGA, Crossroads IGA, IGA Express, American Sun Systems,

Cohen’s Fashion Optical, Employers Risk Services, Food Giant, Four Seasons, Hilliard Lyons, Hitcents, Stephens Pipe & Steel, Tampico, T S Trucking,

Van Meter Insurance, Priceless Foods, Priceless IGA, Subway, Derby’s Pizza & Subs and Taco Del Mar? Yes No

REFERENCE CHECK

Employer Person Contacted Results

TEST RESULTS

Test Administered Raw Score Rating Analysis and Comments

Interview Results

Interviewer Name and Comments

For Employer’s Use Only

REV. 3/13

APPLICATION QUESTIONNAIRE

(Operated by Houchens Food Group)

INSTRUCTIONS: Please answer all of the questions below.

1. Can you submit verification of your eligibility to work in the United States? _____ Yes _____No

If not, your application cannot be processed. You will not be allowed to start work until you

provide verification.

2. Are you at least 18 years of age? _____ Yes _____ No

Have you ever worked for Southern Recycling Inc., Center of Insurance, Inc, Stewart and Richey Construction, Inc,

Pan Osten, Scotty’s Contracting and Stone, Cohen’s Fashion Optical, Hitcents, Van Meter Insurance, Four Seasons,

or in a Houchens Market, IGA, Save-A-Lot Food Store, Foodland, Piggly Wiggly, Sonic Drive-In, Subway, Shell,

Buehlers Buy Low, Scots Markets, Adams & Sullivan, Whites IGA, Priceless Foods, Priceless IGA, Derby’s Pizza

and Subs or Taco Del Mar operated by Houchens Food Group?

_____ Yes _____ No

3. Do you object to working nights? _____ Yes _____ No

4. Do you object to working weekends? _____ Yes _____ No

5. Do you object to working holidays? _____ Yes _____ No

6. Do you object to selling tobacco products? _____ Yes _____ No _____ N/A

7. Have you been convicted of any felony or twice convicted of an misdemeanor involving alcohol

related offenses within the last two years? _____ Yes _____ No _____ N/A

8. Have you had an alcohol license revoked within the last two years? _____ Yes _____ No _____ N/A

9. Would you be willing to take an assignment to another local store? _____ Yes _____ No

10. Do you have a telephone? _____ Yes _____ No

11. What days and hours are you available to work?

Sunday __________to__________

Monday __________to__________

Tuesday __________to__________

Wednesday __________to__________

Thursday __________to__________

Friday __________to__________

Saturday __________to__________

I understand that this Application Questionnaire is a part of the Application for Employment for the position which I

am applying. I hereby certify that the above information is true and correct and that if I am employed, any false

information contained on this Application Questionnaire shall be grounds for the termination of my employment.

___________________ _______________________________

Date Signature of Application

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