Personal Information

Personal Information
Alternate Phone
Do you have a relative or partner employed by the Co-op?
Have you previously been employed by this Co-op?
If hired, can you provide evidence of your right to work in the United States?

Position

$ /hour
Employment Desired

Shift Availability

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Re-order Monday Tuesday Wednesday Thursday Friday Saturday Sunday Weight Operations

Education

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References

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Employment History

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Application Certification

I authorize Community Co-op Market to obtain and verify, verbally or in writing, information about my background and qualifications for employment. I release Community Co-op Market, its officers, directors, agents and employees from any and all claims arising out of obtaining and verification of this information. I also release any person providing information about my background and qualifications for employment from any and all claims that may arise as a result of disclosure. I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that any misrepresentation, falsification, or willful omission of facts shall be sufficient reason for refusal or termination of employment. I understand and agree that if hired, my employment is at will, for no definite period of time and may be ended at any time.
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