White Haven Application

Applicant Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
(###)###-####
Email*
Position(s) Applying For*
Please Specify*
Date Available*
MM slash DD slash YYYY
Desired Wage*

$ Per Hour
Are you a United States Citizen?
- Yes
- No
If no, are you authorized to work in the US?*
- Yes
- No
Have you ever worked for this company?
- Yes
- No
If so, when?*
Have you ever been convicted of a felony?
- Yes
- No
If so, when?*
Are you over the age of 18?
- Yes
- No
May we perform a background check on you?*
- Yes
- No
Can you perform jobs that require you to life 25+ pounds?*
- Yes
- No
What are you interested in working?*
- Part Time
- Full Time
- Temp
Check all that apply
Do you have a valid drivers license?*
- Yes
- No
Can you get to work in most weather conditions?*
- Yes
- No
Can ou get to work without relying on others?*
- Yes
- No
Availability
List approximate times available next to each day. (ex. Monday: 3pm to 10pm)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Education
High School
Address
Street Address Address Line 2 City State ZIP Code
From
To
Did you graduate?
- Yes
- No
Degree
College
Address
Street Address Address Line 2 City State ZIP Code
From
To
Did you graduate?
- Yes
- No
Degree
Other
Address
Street Address Address Line 2 City State ZIP Code
From
To
Did you graduate?
- Yes
- No
Degree
References
Do you know anyone that works / worked for White Haven or Plymouth Markets?*
- Yes
- No
Please tell us who:*
Personal References
Other than relatives and previous employers
Name
First Last
Relationship
Phone
Address
Street Address Address Line 2 City State ZIP Code
Name
First Last
Relationship
Phone
Address
Street Address Address Line 2 City State ZIP Code
Employment History
Please list all present and past employers. Begin with your most recent.
Present/Last Employer
Phone
City & State:
City State
Supervisor
Job Title
Salary

Please enter salary range. Starting and end salary.
Responsibilities
Start Date
MM slash DD slash YYYY

MM/DD/YYYY
End Date
MM slash DD slash YYYY

MM/DD/YYYY
Reason For Leaving
Present/Last Employer
Phone
City & State:
City State
Supervisor
Job Title
Salary

Please enter salary range. Starting and end salary.
Responsibilities
Start Date
MM slash DD slash YYYY

MM/DD/YYYY
End Date
MM slash DD slash YYYY

MM/DD/YYYY
Reason For Leaving
Present/Last employer
Phone
City & State:
City State / Province / Region Country
Supervisor
Job Title
Salary

Please enter salary range. Starting and end salary.
Responsibilities
Start Date
MM slash DD slash YYYY

MM/DD/YYYY
End Date
MM slash DD slash YYYY

MM/DD/YYYY
Reason For Leaving
Disclaimer and Signature
- I certify that the information contained in this application is correct and complete to the best of my knowledge and belief. I understand that any misrepresentation, making false statements, or omission of facts presented on this application may result in rejection of my application or, if employed, in the termination of my employment.
- I authorize the investigation of all information contained herein and consent to a thorough background check. I authorize all employers, schools and references to give White Haven Market, Inc. any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise. I release White Haven Market, Inc. and it’s employees, former employers, schools, and references from all liability for any damage that may result from utilization of such information.
- I understand and agree that no representative of White Haven Market, Inc. 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 the Store Manager.
- I understand that proof of United States citizenship or documentation of the ability to work in the U.S. must be provided at the time of hire. I also understand that I may be asked to submit to routine drug screening.
Signature (type name)*
Date*
MM slash DD slash YYYY
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Equal Opportunity Employer

This company does not and will not discriminate in employment and personnel practices on the basis of race, sex, age, handicap, religion, national origin or any other basis prohibited by applicable law.

Employee Login

White Haven Application

Applicant Information

Availability

Education

References

Personal References

Employment History

Disclaimer and Signature

Equal Opportunity Employer