Employment Application

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Step 1 of 6

Personal Information

First Name

Last Name

Middle Name

Address

City

State

Zip Code

Email Address

Phone Number

Position you're applying for

Store Location

Pine River Family Market - 500 Front Street, Pine River, Minnesota

Rate of pay expected (dollars per hr or yr)

Work Availability Part Time Full Time

If part time, please specify days and hours available

Have you ever applied or worked here? No
Yes

If YES, when and what position?

If hired, what day are you available to start work?

Month:

Day:

Step 2 of 6

Excluding former Employers or Relatives.

Professional References

Reference #1

Name Employer/Company Name
Relationship
Years Known
Email Address (optional)
Daytime Phone
Evening/Cell Phone

Reference #2

Name
Employer/Company Name
Relationship
Years Known
Email Address (optional)
Daytime Phone
Evening/Cell Phone

Reference #3 (Check to use)

Name
Employer/Company Name
Relationship
Years Known
Email Address (optional)
Daytime Phone
Evening/Cell Phone

Reference #4 (Check to use)

Name
Employer/Company Name
Relationship
Years Known
Email Address (optional)
Daytime Phone
Evening/Cell Phone

Step 3 of 6

Employment History

No Previous Employers?

Present or Last Employer

Position/Title
Employer / Company Name
Address
City
State

Start date

Month:
Year:
Rate:

End date

Month:
Year:
Rate:

Describe your work in detail
Reason for Leaving
Name of Supervisor
Position/Title of Supervisor
Supervisor Phone Number

If this is your present employer, may we contact? No
Yes

2nd Previous Employer

Position/Title
Employer / Company Name
Address
City
State

Start date

Month:
Year:
Rate:

End date

Month:
Year:
Rate:

Describe your work in detail
Reason for Leaving
Name of Supervisor
Position/Title of Supervisor
Supervisor Phone Number

3rd Previous Employer

Position/Title
Employer / Company Name
Address
City
State

Start date

Month:
Year:
Rate:

End date

Month:
Year:
Rate:

Describe your work in detail
Reason for Leaving
Name of Supervisor
Position/Title of Supervisor
Supervisor Phone Number

4th Previous Employer

Position/Title
Employer / Company Name
Address
City
State

Start date

Month:
Year:
Rate:

End date

Month:
Year:
Rate:

Describe your work in detail
Reason for Leaving
Name of Supervisor
Position/Title of Supervisor
Supervisor Phone Number

Step 4 of 6

Professional Qualifications

Have you ever served in the armed forces of the United States? No
Yes

If YES, what branch?

Start date

Month:
Year:

End date

Month:
Year:

Rank at discharge

What were your duties in the Service?

If there was any special training you received in the Service, please describe.

Have you ever been bonded? No
Yes

If YES, what job(s)?

Step 5 of 6

Education

Elementary School

Name of School / Issuing Agency
City
State

Years Completed

Did you graduate/receive a degree? No
Yes

High School or Equivalent

Name of School / Issuing Agency
City
State

Years Completed

Did you graduate/receive a degree? No
Yes

If NOT, did you receive a GED? No
Yes

College/Other #1

Name of School / Issuing Agency
City
State

Years Completed

Did you graduate/receive a degree? No
Yes

Major & Minor Fields of Study

College/Other #2

Name of School / Issuing Agency
City
State

Years Completed

Did you graduate/receive a degree? No
Yes

Major & Minor Fields of Study

List any special training or skill development that might apply to this position
List any honors and extra curricular activities that may relate

Step 6 of 6

Emergency & Certification

Person to be notified in case of accident or emergency

Name
Address
Phone Number

Immigration Reform and Control Act of 1986

I understand that if hired, I will be required to offer for examination documents proving that I am a United States citizen or an alien currently authorized to work in the United States. I also understand that my continued employment is contingent upon my providing the necessary documentation within the prescribed time frames.

Applicant's Certification and Agreement

I authorize investigation of my personal or employment history, and of all statements contained in this application. I authorize any former employer, person, firm, corporation, credit agency, or government agency to report any information they may have regarding me, and I release all providers of information from any liability as a result of furnishing this information. I understand that any misrepresentation or omissions in this application shall be considered cause for disqualification from further consideration for hire or for dismissal if discovered subsequent to being hired.

I agree to conform to the rules and regulations of the Company and understand and agree that, if hired, my employment is for no definite period and may, regardless of my designated pay period or salary, be terminated at anytime, for any reason, without any previous notice, at either my or the Company's option. I also understand and agree that no employee of the Company, other than the President, has any authority to enter into any agreement for employment for a specified period, or to make any agreement or representation contrary to the provisions of this Application and Agreement.

The information provided herein is true and accurate to the best of my knowledge. I understand that in the event of information I have provided is found to be untrue or inaccurate then this application may be rejected and/or my employment terminated.

By clicking SUBMIT, I acknowledge that I have read, understand and agree to all of the above statements.

Locally owned and operated, we are proud to offer you the finest in freshness, selection and name-brand products. In addition to offering a wide array of departments from fresh meat and produce to a delicious bakery and deli, we also have a gas station and convenience store on site!

Learn more about our proud tradition >>

Pine River Family Market

500 Front Street, Pine River, MN 56474

Application For Employment

Personal Information

Professional References

Reference #1

Reference #2

Reference #3 (Check to use)

Reference #4 (Check to use)

Employment History

No Previous Employers?

Present or Last Employer

2nd Previous Employer

3rd Previous Employer

4th Previous Employer

Professional Qualifications

Education

Elementary School

High School or Equivalent

College/Other #1

College/Other #2

Emergency & Certification

Person to be notified in case of accident or emergency

Immigration Reform and Control Act of 1986

Applicant's Certification and Agreement

Choose Your Store Location

Pine River Family Market