Lee's Marketplace

Welcome to your local Neighborhood grocer

Join our Team

If you want to be part of a wonderful work environment, and part of an amazing team, please complete and submit the following application. Once the application is reviewed, a memeber of the Lee's Marketplace team will contact you. Or you are welcome to pick up an application at the Customer Service Desk at either one of our stores.

APPLICATION FOR EMPLOYMENT
Position Applied For:
Name:
School Address: (Street, City, State, & Zip)
Home Address: (Street, City, State, & Zip)
Home Telephone:
Mobile/Beeper/Other Phone:
E-mail Address:

If we need to contact you, what is the best time of day?

Have you ever been employed here before?
If yes, give dates and positions

Yes
No

Are you legally eligible for employment in this country?

Yes
No

Date available for work:

What is your desired salary range?

Type of employment desired:	Full-Time	Part-Time
	Temporary	Seasonal
	Educational Co-Op

Are you able to meet the attendance requirements of the position?

Yes
No

Have you ever pled "guilty" or "no contest" to, or been convicted of a crime?

Yes
No

Answering "yes" to these questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.

EMPLOYMENT HISTORY
Provide the following information of your past four (4) employers, assignments or volunteer activities, starting with the most recent.
Employer #1:
Address: (Street, City, State, & Zip):
Telephone #:
Immediate Supervisor and Title:
From Date:
To Date:
Starting Job Title:
Ending Job Title:
Summarize the Nature of Work Performed and Job Responsibilities:
Hourly Rate/Salary (Start and Final):
Reason For Leaving:
May We Contact For Reference?	Yes No

Employer #2:
Address: (Street, City, State, & Zip):
Telephone #:
Immediate Supervisor and Title:
From Date:
To Date:
Starting Job Title:
Ending Job Title:
Summarize the Nature of Work Performed and Job Responsibilities:
Hourly Rate/Salary (Start and Final):
Reason For Leaving:
May We Contact For Reference?	Yes No

Employer #3:
Address: (Street, City, State, & Zip):
Telephone #:
Immediate Supervisor and Title:
From Date:
To Date:
Starting Job Title:
Ending Job Title:
Summarize the Nature of Work Performed and Job Responsibilities:
Hourly Rate/Salary (Start and Final):
Reason For Leaving:
May We Contact For Reference?	Yes No

Employer #4:
Address: (Street, City, State, & Zip):
Telephone #:
Immediate Supervisor and Title:
From Date:
To Date:
Starting Job Title:
Ending Job Title:
Summarize the Nature of Work Performed and Job Responsibilities:
Hourly Rate/Salary (Start and Final):
Reason For Leaving:
May We Contact For Reference?	Yes No

SKILLS AND QUALIFICATIONS
Summarize any training, skills, licenses and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying:

EDUCATIONAL BACKGROUND (IF JOB RELATED)
High School (name & location):
Number of Years Completed:
Did you Graduate?	Yes No

College (name & location):
Number of Years Completed:
Did you Graduate?	Yes No
Major:
Degree:

Other (name & location):
Number of Years Completed:
Did you Graduate?	Yes No
Course of Study:

REFERENCES
Name:
Telephone:
Number of Years Known:

Name:
Telephone:
Number of Years Known:

Name:
Telephone:
Number of Years Known:

APPLICANT STATEMENT

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer's service, whenever it is discovered.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering, and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the forgoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 form in this regard.

DO NOT INITIAL OR SUBMIT UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement:

Initials:

"You've Got a Friend at Lee's"