Fillable Printable Piggly Wiggly Application Form
Fillable Printable Piggly Wiggly Application Form
Piggly Wiggly Application Form
Piggly Wiggly
Illinois Employment Application
Name: Soc. Sec #: Today’s Date:__________
Last First M.I.
Address: ____________________________________________________________________________________________________
Street City State Zip
Drivers License #:__________________________________________ Phone #:___________________________________________
Position applying for:
Are you at least 16 years old? Yes No If under 18, your birthdate____________ Are you at least 18 years old? Yes No
Are you applying for part-time work or full-time work? (please circle)
Are you available to work (please circle): Mornings Afternoons Evenings Weekends Anytime
Number of hours you are available to work per week (please circle) 12-16 16-20 20-24 24-28 28-32 32-36 36-40
Date you would be available to begin work?
Employment History ( List current or most recent job first, and continue with preceding jobs.) Add additional sheets if needed.
May we contact your previous supervisor(s) for a reference? Yes No
______________________________ _______________________________________________ _________________________
Name of Employer Address Supervisor
_____________________________ _______________________________________________ __________________________
Phone Number Hired (Month, Year) Salary @ end
___________________________________________________________ ______________________________________________
Job Duties Reason for leaving and date
______________________________ _______________________________________________ _________________________
Name of Employer Address Supervisor
_____________________________ _______________________________________________ __________________________
Phone Number Hired (Month, Year) Salary @ end
___________________________________________________________ ______________________________________________
Job Duties Reason for leaving and date
______________________________ _______________________________________________ _________________________
Name of Employer Address Supervisor
_____________________________ _______________________________________________ __________________________
Phone Number Hired (Month, Year) Salary @ end
___________________________________________________________ ______________________________________________
Job Duties Reason for leaving and date
Other References (please list)
Name Telephone Relationship Years Known
FORM500/ILLINOIS/WORD/JULY2014 (OVER)
Educational History
High School
Counselor:
School Name Did you graduate? Yes No
GPA:
Grade completed : 9 10 11 12
Address
College, University, or Technical School
Did you earn a degree? Yes No
Please list degree earned:
School Name
GPA:
Years Completed: 1 2 3 4 5 5+
Address
Are you involved in any activities, which would conflict with your assigned work schedule? Yes No
List any training, skills, and qualifications which you feel are relevant to the type of employment you are seeking here:
Have you ever been convicted of a felony or misdemeanor crime that has not been removed from your record?
Yes No If yes, state date, place, and nature of conviction*
*Note: A criminal record does not constitute an automatic bar to employment, it will only be considered as it relates to the job for which you are
applying. You are not required nor will you be asked to report whether you have a sealed conviction or arrest.
Have you ever been discharged or asked to resign from any position? Yes No If yes, please explain
Please read carefully before signing.
I authorize Piggly Wiggly to make an investigation of all information contained in this employment application and I will release from
liability Piggly Wiggly, including it’s parent corporation, subsidiaries, affiliates, employees, agents, officers, directors, or any other parties
acting on it’s behalf, and all companies and corporations supplying such information. It is understood and agreed that any
misrepresentation or omission by me in this application will lead to cancellation of this application and/or termination from Piggly Wiggly.
Furthermore, I understand that my employment at Piggly Wiggly is at will, meaning I may quit or be dismissed at any time. No employee
references will be given for former Piggly Wiggly employees, unless written approval is granted by the said employee at termination.
Piggly Wiggly is an equal opportunity employer. As an equal opportunity employer we intend to comply fully with all local, state, and
federal laws. Piggly Wiggly does not discriminate or give preference to employment on the basis of race, sex, age, religion, color, national
origin, disability, or any other basis prohibited by law. No question on this application is used for the purpose of limiting or excluding any
applicant’s consideration for employment on a basis prohibited by local, state, or federal law.
This application is current for only 90 days, if you have not heard from Piggly Wiggly and still wish to be considered for employment, it
will be necessary for you to fill out a new application.
Piggly Wiggly prohibits the use of illegal substances in the workplace. To that end, the company may conduct drug testing on all
individuals who receive a conditional offer of employment. The company may also require you to pass a post-job offer physical
examination.
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Signature of applicant Date
