Applicant Information
Location Applying To
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Date Available*
Desired Salary
Primary Position Applying For*
Primary Position Time*
- Part-Time
- Full-Time
Second Choice Position
Second Choice Position Time
- Part-Time
- Full-Time
Personal Information
Are you a United States Citizen?
- Yes
- No
If no, are you authorized to work in the US?
- Yes
- No
Have you ever applied for work with ShurSave Markets?
- Yes
- No
If so, when?
Are you currently employed?
- Yes
- No
If so, are we authorized to contact your current employer?
- Yes
- No
Were you referred to us by someone?
- Yes
- No
If so, who?
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
From
To
Degree
College
Address
From
To
Degree
Other
Address
From
To
Degree
References
Name
First Last
Relationship
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name
First Last
Relationship
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name
First Last
Relationship
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Previous Employment
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From
To
Reason For Leaving
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From
To
Reason For Leaving
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From
To
Reason For Leaving