Employment Form

Personal Information
15 or under 16-17 18 and over
Yes No
Yes No
Yes No
Yes No
Bakery Cashier Stocker Fuel Center Deli/Food Service Market Produce Pharmacy Frozen/Dairy Courtesy/Utility Clerk Transportation Manufacturing Warehouse Facility Services Administrative Office
Please List Hours of Availability
Monday
Any Time (day or night)
Add Additional Time
and
Tuesday
Any Time (day or night)
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and
Wednesday
Any Time (day or night)
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and
Thursday
Any Time (day or night)
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and
Friday
Any Time (day or night)
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and
Saturday
Any Time (day or night)
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and
Sunday
Any Time (day or night)
Add Additional Time
and
Holidays Nights Weekends Variable Shifts Rotating Shifts

Yes No
Yes No
Education
1
Work History

Please list your most recent employment history, beginning with your current employer (if employed). Please be prepared to explain any gaps in your work history.

Employer 1

to
Yes No

Employer 2

to
Yes No

Employer 3

to
Yes No
References

Please list the names and phone numbers of three references (excluding relatives) we may contact.

Resume

Please attach your resume below

Upload a file
Application Agreement

I certify that the information contained in this application or provided by me is true and complete to the best of my knowledge, and understand that false statements or omissions made on the application or during the interview process are grounds for dismissal from employment, regardless of when discovered. I acknowledge that any information provided on this application that is not specifically requested or does not directly respond to a question will not be considered for employment purposes. I understand this application does not constitute a contract for employment and if I am hired, that my employment can be terminated with or without cause or notice at the discretion of myself or Brookshire Grocery Company.

By submitting this application, I hereby release Brookshire Grocery Company, its directors, officers, employees and/or agents from all liability for damages of any kind that may result from them obtaining information about my employment history, education, criminal conviction record, credit history, driving or motor vehicle records, licensing or certification record for use in connection with my potential employment.

I understand that Brookshire Grocery Company believes in operating a drug-and-alcohol-free workplace, and all offers of employment are conditional upon successfully passing a drug and/or alcohol test. Continued employment thereafter is also conditional upon successfully passing a drug and/or alcohol test whenever requested by the Company. I hereby release Brookshire Grocery Company, its officers, agents, and employees from any claims or liability arising out of or related to the enforcement of its Alcohol and Drug Abuse policy, including but not limited to, all claims for injuries to my person or damage to my reputation resulting from drug and alcohol testing and searches or the release of information concerning such testing or searches.

I understand that a photocopy of this authorization shall have the same force and effect
as the original. *

I Agree I Do Not Agree
Submit Your Application

You can submit your completed application to us electronically by clicking the Submit Button below, or if you prefer you can click the Print Button to view a printer friendly version of your completed application.

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