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Fillable Printable Houchens Industries Application for Employment Form

Fillable Printable Houchens Industries Application for Employment Form

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
Yes No
Yes No
Yes No
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
1
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
2
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
3
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
4
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
or
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,
Cohens 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
1
2
3
4
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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