Fillable Printable IGA Job Application Form
Fillable Printable IGA Job Application Form
IGA Job Application Form
IGA is an Equal Opportunity Employer and will not discriminate on the basis of race, color, religion, sex, national origin,
disibility, veteran status, age, marital status, sexual orientation or other legally protected characteristics.
I understand that by filling out this application there is no guarantee that I will be hired. IGA reserves the right to withdraw
any offer of employment at any time; similarly, the applicant has the right to withdraw this application at any time. If you wish to submit
a resume, you may attach it to this application but, in addition, you must complete this application, including
employment history, and answer all questions fully and accurately.
NAME
LAST FIRST MIDDLE OTHER NAMES UNDER WHICH YOU HAVE WORKED
ADDRESS
NUMBER AND STREET APT # CITY STATE ZIP CODE
TELEPHONE # SOCIAL SECURITY #
POSITION(S) DESIRED:
I AM AVAILABLE FOR: DATE AVAILABLE FOR WORK:
FULL TIME PART TIME ON-CALL
DAYS NIGHTS GRAVEYARD
WEEKENDS HOLIDAYS
Have you ever been employed by IGA? Yes No If yes, when? Dept?
Are you legally permitted to be employed in the United States? Yes No
(If hired, we will require verification of employment eligibility.)
If hired for a position involving the handling and/or serving of alcoholic beverages, Arizona Law requires you to be
at least 19 years of age. Do you qualify? Yes No
Have you been convicted of a felony in the last 7 years?
Yes No
If yes, please explain fully (Note: A conviction does not necessarily prohibit employment.)
LAST YEAR DEGREE
EDUCATION SCHOOL ATTENDED CITY/ STATE COMPLETED RECEIVED MAJOR / MINOR
HIGH SCHOOL 9 10 11 12
COLLEGE/ UNIVERSITY 1 2 3 4
OTHER 1 2 3 4
SPECIAL TRAINING SKILLS
Calculator Typing ______ words per minute
List any skills that may enhance your qualifications for
Cash register Shorthand ______ words per minute employment. These may include, but are not limited to fluency
PBX console 10-Key adding machine in a language other than English.
Dictation equipment Computer - (list software)
EMPLOYMENT HISTORY
Start with the most recent employer. All first time must be accounted for. Include part-time, tempory and contract
positions.
Date Hired: NAME OF EMPLOYER NAME AND TITLE OF IMMEDIATE SUPERVISOR
Mo Yr
Date Left: ADDRESS OF EMPLOYER PHONE REASON FOR LEAVING
Mo Yr
POSITION HELD AND DUTIES May we contact this employer?
Yes No
Date Hired: NAME OF EMPLOYER NAME AND TITLE OF IMMEDIATE SUPERVISOR
Mo Yr
Date Left: ADDRESS OF EMPLOYER PHONE REASON FOR LEAVING
Mo Yr
POSITION HELD AND DUTIES May we contact this employer?
Yes No
Date Hired: NAME OF EMPLOYER NAME AND TITLE OF IMMEDIATE SUPERVISOR
Mo Yr
Date Left: ADDRESS OF EMPLOYER PHONE REASON FOR LEAVING
Mo Yr
POSITION HELD AND DUTIES May we contact this employer?
Yes No
Date Hired: NAME OF EMPLOYER NAME AND TITLE OF IMMEDIATE SUPERVISOR
Mo Yr
Date Left: ADDRESS OF EMPLOYER PHONE REASON FOR LEAVING
Mo Yr
POSITION HELD AND DUTIES May we contact this employer?
Yes No
Have you ever been fired, dismissed, asked to resign or otherwise terminated from any job? Yes No
(Note: A yes answer does not necessarily prohibit employment.) If yes, what job, when and why?
Please advise us of your wage requirements. From: $ to $
Date Signature
