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 Personal Information      * Required Fields
* How were you referred to us?:
*  applying for (Please Choose)




Stock clerks Deli Associates
Bakery Associates
Meat Cutter
Meat Wrapper
Produce Associates
Kitchen Associates
Chef



 

* Your First Name:
* Your Middle Name:
* Your Last Name:
* Your Address:
* City:
* State:
* Zip:
* Your E-mail:
* Phone Number:
* Mobile/Other:
* 18 Years Or Older:
* If NO, please explain:
* Date You Can Start:
* Do you know anyone or have relatives employed by Pat"s
*If Yes, Name:
*Relationship:
*Department:
* Are you a citizen of the United States?
* If not are you legally allowed to work in the United States?
* Have you worked here before:
* If YES, When:
  Education Information
High School-Name
Location:
Years Compleated: 11
Did you graduate?
Degree/course of study:
College-Name
Location:
Years Compleated: 3
Did You graduate?
Degree/course of study:
Other-Name
Location:
Did you graduate?
Degree/course of study:
  Job Information
* What prompted Your Application:



Positions applyed for:
Position:
expected pay rate
position:
expected pay rate

Specify days and hours you are able to work:
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:
* Type of employment desired:


 Legal History

* Ever been convicted of a Felony?
* If YES, give dates/details:
Answering "yes" to this questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.
  Other Comments

Occasionally the form of an application blank makes it difficult for individuals to adequately summarize their complete background.

With that in mind please list any other special skills or qualifications that you would like us to consider.

   
   Previous Employment (begin with most recent position):
Dates of Employment: From:   To:   
Positions(s) Held:
Firm / Company: 
Address of Employer:  
Company Phone Number:  
Supervisor:  
Title of Supervisor:  
Your Responsibilities:  
Start Annual Income & Title:  
End Annual Income and Title:  
Reason for Leaving:  
May we contact this employer for reference ? Yes     No  
   
   Previous Employment
Dates of Employment: From:   To:   
Positions(s) Held:
Firm / Company: 
Address of Employer:  
Company Phone Number:  
Supervisor:  
Title of Supervisor:  
Your Responsibilities:  
Start Annual Income & Title:  
End Annual Income and Title:  
Reason for Leaving:  
May we contact this employer for reference ? Yes     No  
   
   Previous Employment
Dates of Employment: From:   To:   
Positions(s) Held:
Firm / Company: 
Address of Employer:  
Company Phone Number:  
Supervisor:  
Title of Supervisor:  
Your Responsibilities:  
Start Annual Income & Title:  
End Annual Income and Title:  
Reason for Leaving:  
May we contact this employer for reference ? Yes     No  
   


OPTIONAL

ATTACH YOUR RESUME

PDF OR WORD FILES ONLY

APPLICANT'S STATEMENT

AUTHORIZATION

I authorize present and former employers, and individuals I have listed as personal references, to furnish information about my employment record, including a statement of the reason for the termination of my employment, work performance, abilities, and other qualities pertinent to my qualifications for employment, herby releasing them from any and all liability for damages arising from furnishing the requested information.

I certify that the information contained in this application is correct to the best of my knowledge. If employed, I understand that the falsification of this information may result in my dismissal. I authorize the investigation of all statements contained in this application for employment as necessary in arriving at an employment decision. I understand that my employment may be terminated, with or without notice, by the Company for any reason, including lack of work, unsatisfactory performance, improper behavior or any other reason which, in the sole judgment of the Company, constitutes a basis for termination of employment.




Security test. Please identify the pictures:

 


I agree to the AUTHORIZATION

      

 

 

 

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