Last Name:  

   First Name:  

       Address:  

    Address 2: 

              City:       State:       Zip:  

Home Phone:    Cell Phone: 

          E-mail: 

Are you acquainted with anyone who is, or was employed by Al's Country Market?  Yes     No
If yes, whom? 

How were you referred to us? 

Are you a U.S. Citizen or are you eligible to work in the U.S.?  Yes     No

Have you pled "guilty" or "no contest" to or been convicted of a crime in the last 5 years?  Yes     No

If yes, please explain: 

What type of employment schedule are you looking for?
Full-time   Part-time   Seasonal

How many hours would you like to work each week?
10 - 20    21 - 34    35 - 40    40+ hours

When are you available?

  Days Nights Both Neither
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

When are you available to start?      

What position are you applying for? 

Do you have previous experience in the position you are applying for?
Explain: 

List your relevant recent experience:

Employer Position Dates Employed May we contact? Phone Number
Yes    No
Yes    No
Yes    No
Yes    No

Is there anything else you'd like us to know about you that might help us consider you for the position?

Please click on submit after you have completed.