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Employment Application Form

Step 1 of 4

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Employment Preferences
Location Preference*
- Oxendale’s Market Minneapolis Nokomis
- Oxendale’s Market West St. Paul
- Oxendale’s Market St. Paul Randolph Ave
- Widmer’s Supermarket St. Paul
Position Preference
Date You Can Start
MM slash DD slash YYYY
Salary Desired
Number of Hours Desired per Week
Have you applied to this company before?*
- Yes
- No
Where did you apply?*
- Oxendale’s Market Minneapolis Nokomis
- Oxendale’s Market West St. Paul
- Oxendale’s Market St. Paul Randolph Ave
- Widmer’s Supermarket St. Paul
When did you apply?
Have you worked for this company before?*
- Yes
- No
Where did you work and what date range(s)?
Personal Information
Name*
First Last
Present Address*
Street Address Address Line 2 City State ZIP
Is your Present Address your Permanent Address?*
- Yes
- No
Permanent Address
Street Address Address Line 2 City State ZIP
Your Phone Number*
Your Email Address
Are you over the age of 18?*
- Yes
- No
Please provide the name of a parent/guardian we can contact:*
First Last
Phone Number for Parent/Guardian*
Referred by
First Name, Last Name & Location

Employment History
Are you currently employed?*
- Yes
- No
May we contact your current employer?*
- Yes
- No
Would working with our company be your first job?*
- Yes
- No
Former Employers
Please provide information for your FOUR most recent employers, starting with your most recent position.
Name of most recent (or current) Employer*
Dates of Employment (MM/YYYY-MM/YYYY)
Who can we contact?
First Name Last Name
Phone Number
Company Address
Street Address City State ZIP Code
Your Position
Reason for Leaving
SECOND most recent employer
If you have no more positions to report, please enter “End of History” for the Employer name.
Employer name*
Dates of Employment (MM/YYYY-MM/YYYY)
Company Address
Street Address City State ZIP Code
Your Position
Reason for Leaving
THIRD most recent employer
If you have no more positions to report, please enter “End of History” for the Employer name.
Employer Name*
Dates of Employment (MM/YYYY-MM/YYYY)
Company Address
Street Address City State ZIP Code
Your Position
Reason for Leaving
FOURTH most recent employer
If you have no more positions to report, please enter “End of History” for the Employer name.
Employer name*
Dates of Employment (MM/YYYY-MM/YYYY)
Company Address
Street Address City State ZIP Code
Your Position
Reason for Leaving

Education History
High School
Name Years Attended City State/Province
Did you graduate?
- Yes
- No
College, Trade School or other post High School Education
Name Years Attended City State/Province
Did you graduate?
- Yes
- No
Subject(s) Studied
Additional Information
Additional Experience
If you have any other subjects of special study, research work, special training or skills you’d like to mention, please list that here.
Have you served in the military?
- Yes
- No
Branch of service
Rank

References
Please list the names and phone number of three people not related to you, whom you have known for at least a year.
Name*
Phone*
Years Known*
How do they know you?*
Name
Phone
Years Known
How do they know you?
Name
Phone
Years Known
How do they know you?
Authorization for Submission
Authorization*
I agree to the following:
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained here in and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.
Phone
This field is for validation purposes and should be left unchanged.

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