Anderson Food Shops

View a list of our positions
and their descriptions here

Apply Online by Completing the Form Below:
** Items in RED are REQUIRED **

At Anderson Food Shops, we value our work family.
Background checks are completed for all new hires.
Discrepancies on background checks may prevent the hiring process to be completed.

Thank you!

Personal Data

Contact Information

First Name	Middle Initial	Last Name
Social Security No. ###-##-####	Telephone (402) 555-5555	Alt Telephone (402) 555-5555
Present Street Address
Present Street Address 2 (Suite Number, Apartment Number, etc... )
City	State	Zip Code

Have you ever been employed by Anderson Food Shops or any of it's affiliates?			Yes No
If YES, please complete the following:
From (mo/yr)	To (mo/yr)	Location of Employment	Position

Do you have reliable transportation?	Yes No
Were you referred by a Anderson Food Shops staff member? If YES, whom?	Yes No

Employment Eligibility

Are you a U.S. citizen or authorized to work in the U.S. on an unrestricted basis?	Yes No
Can you, after employment, submit proof of your legal right to work in the U.S.?	Yes No
Have you ever been convicted of a misdemeanor or a felony, or do you currently have any criminal cases pending? If YES, please give the date, location, and disposition of your case.	Yes No

In case of emergency please call:

Full Name	Relationship	Phone (402) 555-5555
Emergency Contact's Street Address
Emergency Contact's Street Address 2 (Suite Number, Apartment Number, etc... )
City	State	Zip Code

Position Information

Please select the current open position you are most interested in:
   Sales Associate (Full Time) at 120th & Pacific
   Sales Associate (Part-time) at 156th & Dodge
   Sales Associate (Full Time) at 114th & Davenport
   Sales Associate (Part-time) at 180th & Center

Other position, not currently listed.

Would you like us to consider you for other postions?

Yes No

*I understand that applicants who do not meet the minimum qualifications of the position will not be considered for the position. Only those final candidates will be contacted.

Desired starting pay:

Per Hour OR Per Week

How many hours a week do you want to work?

10 20 30 40+

During what times are you available to work?

Days
7am-3pm

Evenings
3pm-11pm

Nights
11pm-7am

Weekends

Please mark the days you are NOT available to work.

Mon.

Tues.

Wed.

Thurs.

Fri.

Sat.

Sun.

When could you begin work?

Are you at least 16 years of age?

Yes No

Are you at least 19 years of age?

Yes No

Are you at least 21 years of age?

Yes No

Positions require minimal lifting ability (approx. 20lbs.). Do you have any injuries or physical conditions that will impair your ability to lift products?

Yes No

Employment History

Are you presently employed?	Yes No
May we contact your present employer?	Yes No
Have you ever worked in a convenience store or a petroleum company? If so, and not noted in sections below, who:	Yes No

Most Recent Employer

From (mo/yr)	To (mo/yr)	Employer Name	Job Title
Duties
Street Address
Street Address 2 (Suite Number, Apartment Number, etc... )
City		State	Zip Code
Supervisor's Full Name			Supervisor Phone (402) 555-5555
Reason for Leaving

Other Employer #1

From (mo/yr)	To (mo/yr)	Employer Name	Job Title
Duties
Street Address
Street Address 2 (Suite Number, Apartment Number, etc... )
City		State	Zip Code
Supervisor's Full Name			Supervisor Phone (402) 555-5555
Reason for Leaving

Other Employer #2

From (mo/yr)	To (mo/yr)	Employer Name	Job Title
Duties
Street Address
Street Address 2 (Suite Number, Apartment Number, etc... )
City		State	Zip Code
Supervisor's Full Name			Supervisor Phone (402) 555-5555
Reason for Leaving

Other Employer #3

From (mo/yr)	To (mo/yr)	Employer Name	Job Title
Duties
Street Address
Street Address 2 (Suite Number, Apartment Number, etc... )
City		State	Zip Code
Supervisor's Full Name			Supervisor Phone (402) 555-5555
Reason for Leaving

Please list any special qualifications, training, education, skills or experience that you feel warrant consideration by the company:

Briefly explain why you are interested in a position with our company:

Education

Did you graduate from high school or earn a GED?

Yes No

College, University, Business or Trade School Information

Name of Institution	City	State
Full-Time Part-Time	Major Field of Study
Degree Conferred	Hours of Credit

How Did Your Hear About Us?

In-Store Promotion	Recruitment Card	Employee Referral	Agency
Advertisement	Rehire	Internet	Other

PLEASE READ CAREFULLY
I hereby certify that the answers to the foregoing questions are true to the best of my knowledge and agree to have any of the statements checked by Anderson Food Shops unless I have indicated to the contrary.

I am aware that a more detailed investigation concerning background and credit checks for management positions only may also be conducted, if applicable to the job for which I am applying, and I hereby authorize such an investigation.

I understand that employment is contingent upon satisfactory completion of reference checks and that, upon my written request, information on the nature and scope of an inquiry, if one is made, will be provided to me.

I understand that nothing contained in this employment application is intended to lead to or create an employment contract between Anderson Food Shops or any subsidiary or affiliate and myself which would in any way restrict the right of the company to terminate my employment at will.

I further understand and agree that the employment relationship that may result from my application will be employment-at-will, and either I or Anderson Food Shops or any subsidiary or affiliate may terminate the relationship at any time.

I understand that any omission, misrepresentation or falsification can be grounds for refusal of employment. I further understand that, if employed, any false statements or misrepresentations herein or in conjunction with the application process may be cause for dismissal.

I understand that any and all disputes regarding my employment with Anderson Food Shops, including any disputes relating to the termination of my employment, are subject to the Anderson Food Shops Company Policy. I also understand and agree, as a condition of employment and continued employment, to submit any such disputes in accordance with Company Policy.

Application Certification
Please type your initials and email address in the following boxes. By doing so and submitting this form to Anderson Food Shops you are agreeing to the terms and conditions stated above.

Your Initials

Email Address

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