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APPLICATION FOR EMPLOYMENT
Application Note: This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are ground for terminating the application process or if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination based on sex, marital status, race, color, age, creed, national origin, sexual orientation, military reserve membership, ancestry, religion, height, weight, use of guide or support animal because of blindness, deafness, or physical handicap, or the presence of disabilities. A conviction will not necessarily bar an applicant from employment. Additional testing for the presence of drugs in your body will be required prior to employment. Rowe’s believes in Equal Opportunity in relation to hiring, promotions, layoffs, discharges, and rates of pay, training, and other employment activities. Rowe’s abides by the principles of the Age Discrimination in Employment Act and the Americans with Disabilities Act.
POSITION(S) DEPARTMENT(S) APPLIED FOR:*
- Select All
- Cashier
- Grocery Department
- Meat Department
- Produce Department
- Bakery / Deli
- other
ARE YOU LOOKING FOR*
- FULL TIME
- PART TIME
WERE YOU PREVIOUSLY EMPLOYED BY US?*
WHAT LOCATION*
START DATE*
Month
Day
Year
END DATE*
Month
Day
Year
ARE YOU LEGALLY ELIGIBLE TO WORK IN THE U.S?*
ARE YOU OVER THE AGE OF 18*
DO YOU HAVE OR HAD ANY RELATIVES WORK(ING) AT ROWES?*
IF SO WHEN? START MONTH*
START YEAR*
END MONTH (IF ANY)
END YEAR (IF ANY)
WHICH LOCATION?*
WHAT DATE ARE YOU AVAILABLE TO START?*
MM slash DD slash YYYY
DO YOU HAVE ANY SCHEDULE RESTRICTIONS*
PLEASE EXPLAIN*
PLEASE SELECT YOUR AVAILABILITY
(Select all that apply)
MONDAY
- AM
- PM
TUESDAY
- AM
- PM
WEDNESDAY
- AM
- PM
THURSDAY
- AM
- PM
FRIDAY
- AM
- PM
SATURDAY
- AM
- PM
SUNDAY
- AM
- PM

PERSONAL CONTACT INFORMATION
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
HOME PHONE
CELL PHONE*
SSN*

MILITARY SERVICE RECORD
WERE YOU IN THE ARMED FORCES?*
WHAT BRANCH*
ARE YOU STILL IN THE ARMED FORCES?*
WHEN WERE YOU IN THE ARMED FORCES | START DATE*
Month
Day
Year
END DATE*
Month
Day
Year

CRIMINAL RECORD
HAVE YOU EVER BEEN CONVICTED OF AN OFFENSE OTHER THAN A MINOR TRAFFIC VIOLATION IN THE PAST SEVEN YEARS? (INCLUDE CONVICTIONS BY MILITARY COURT MARTIAL)*
EXPLAIN EACH CONVICTION WITH A DATE OF CONVICTION, NATURE OF CHARGE, AND SENTENCE RECEIVED:*

EDUCATION
HIGH SCHOOL
NAME
LOCATION
LAST GRADE COMPLETE
GRADUATION DATE
Month
Day
Year
DID YOU ATTEND COLLEGE*
DO YOU HAVE ANY OTHER FORMS OF EDUCATION?*
COLLEGE
NAME
LOCATION
FIELD OF STUDY
LAST GRADE COMPLETED
GRADUATION DATE
MM slash DD slash YYYY
OTHER
NAME
COURSE DESCRIPTION
GRADUATION/COMPLETION DATE
Month
Day
Year

PREVIOUS EMPLOYMENT
Begin with the most recent position. Include volunteer experience which relates to the job for which you are applying for.
EMPLOYER*
TYPE OF BUSINESS*
Address*
Street Address Address Line 2 City State ZIP Code
PHONE*
ARE YOU CURRENTLY EMPLOYED WITH THIS EMPLOYER?*
WHEN WAS YOUR START DATE?*
MM slash DD slash YYYY
WHEN WAS YOUR START DATE*
MM slash DD slash YYYY
END DATE*
MM slash DD slash YYYY
STARTING SALARY*
ENDING SALARY*
REASON FOR LEAVING*
SUPERVISOR NAME*
MAY WE CONTACT?*
DESCRIBE THE WORK YOU DID AND YOUR JOB RESPONSIBILITIES*
DO YOU HAVE MORE EMPLOYMENT HISTORY*
EMPLOYMENT HISTORY #2
EMPLOYER
TYPE OF BUSINESS
Address
Street Address Address Line 2 City State ZIP Code
Phone
START DATE
MM slash DD slash YYYY
END DATE
MM slash DD slash YYYY
STARTING SALARY*
ENDING SALARY
REASON FOR LEAVING
SUPERVIOSR NAME
MAY WE CONTACT
DESCRIBE THE WORK YOU DID AND JOB RESPONSIBILITIES
DO YOU HAVE MORE EXPERIENCE YOU WOULD LIKE TO ADD?
EMPLOYMENT HISTORY #3
EMPLOYER*
TYPE OF BUSINESS*
Address
Street Address Address Line 2 City State ZIP Code
Phone
START DATE
Month
Day
Year
END DATE
MM slash DD slash YYYY
STARTING SALARY
ENDING SALARY
REASON FOR LEAVING
SUPERVISOR NAME
First Last
MAY WE CONTACT
DESCRIBE THE WORK YOU DID AND JOB RESPONSIBILITIES

INDICATE ANY OTHER EXPERIENCE, SKILLS CERTIFICATIONS OR JOB-RELATED TRAINING

Consent*
I agree to the privacy policy.
I certify that I have read and understand the applicant note on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief, and I release any and all parties from any and all liability for any and all statements, writing, conversations, or communications, of any form, with this Employer regarding any entry on this form and other material I have provided. I understand that any false information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection of my application or discharge at any time during my employment. As a part of this application for employment, I hereby authorize Rowe’s to investigate my references and to make an independent investigation of my character, conduct and employment records, and to keep and preserve such records. I authorize the company and/or its agents, including consumer reporting bureaus, to verify any of this information. I release all former employers, persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information.

I understand that this employment application and any other company documents do not constitute a contract of employment and that if hired, I agree that my employment is at-will and I agree to abide by all Company work rules, policies, and procedures and that I or the company may terminate employment at any time for any reason.

I also understand that the use of illegal drugs is prohibited during employment. Upon offer of employment, I agree to take any lawful examination or test, including any drug and/or alcohol test, required by the company as a condition of my being hired, or if I am hired, as a condition of my continued employment. I further agree that my refusal to take any such lawful examination or test constitutes grounds for, and will cause the company not to employ me, or if I am employed, to terminate my employment. I release the company and all named and unnamed sources from any and all liability which may result from any lawful examination or test.
Signature*
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Comments
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About Rowe’s

Rowe's Supermarket is your hometown store for "Fresh for Less" shopping. Our wide variety of international foods means we bring the world to your neighborhood. Join the Fresh for Less team today!

(904) 652-1640

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