Suresave Stores Employment Application

Sure Save Stores
Application For Employment

Puna Fresh Foods, Island Market, Wiki-Wiki Marts, and Administrative Services

* Required

*Last Name

*First Name

*Address

*City

*State

*Zip Country

Phone
(digits only, no spaces)

*Day *Night Cell/Mobile

Social Security Number (optional)

e-mail Address (Optional)

Confidential - for employment application purposes only. Privacy Policy

Have you ever worked for Sure Save Supermarkets, WikiWiki Marts, or Island Markets before? Yes No If Yes Check All That Apply below

Positions Held		Stores/Locations Worked
Courtesy Clerk Cashier Merchandising & Stocking Meat Department Produce Department Food Service	Floral Department Frozen Foods Department Health & Beauty Care General Merchandi Front Office	Keaau Market Island Markets - Naalehu WikiWiki Mart - Kam. Ave WikiWiki Mart - Kawailani WikiWiki Mart - Orchidland WikiWiki Mart - Mauna Lani WikiWiki Video

Reason for Leaving:

*Are you at least 18 years of age?

Yes
No, My Work Permit Number is:

Position Applying For:

*
*

Other (Write In)

Why are you applying for this position?

Store Location
(Select All Desired)

Keaau Market
Island Markets - Naalehu
WikiWiki Mart - Kam. Ave
WikiWiki Mart - Kawailani
WikiWiki Mart - Orchidland
WikiWiki Mart - Mauna Lani
WikiWiki Video

Type Of Employment
(Check All Desired)

Full Time
Part Time

Days
Nights

Weekends
Holidays

Days and times you are available for work	Day	From	To	Any Day or Time
	Sunday
	Monday
	Tuesday
	Wednesday
	Thursday
	Friday
	Saturday

Machines You Are
Able To Operate
(Check All That Apply)

Calculator
10 Key: SPM:
Computer:
Operating Sys:

Cash Register
Typewriter - WPM:

Other:
PUC License Type:

Expected Rate of Pay

Fork Lift:

Education and Training

High School

Name Location
Years Attended Graduated? Yes No GPA

Business/Trade School

Name Location
Years Attended Graduated? Yes No GPA
Degree/Major

College or University

Name Location
Years Attended Graduated? Yes No GPA
Degree/Major

Attach Résumé Transcripts or Photo

Send Attachments

What are your future educational plans?

Employment History
Start with most recent

Employer #1 (Current or most recent)

If currently employed, may we contact your present employer? Yes No

From:

To:

Name of employer

Address

City

State

Zip: Phone:

Supervisors name:
Supervisors Title:

Job Title and Major Duties

Starting Rate:

Ending Rate: Type:

Reason for leaving

Employer #2

From:

To:

Name of employer

Address

City

State

Zip: Phone:

Supervisors name:
Supervisors Title:

Job Title and Major Duties

Starting Rate:

Ending Rate: Type:

Reason for leaving

Employer #3

From:

To:

Name of employer

Address

City

State

Zip: Phone:

Supervisors name:
Supervisors Title:

Job Title and Major Duties

Starting Rate:

Ending Rate: Type:

Reason for leaving

Employer #4

From:

To:

Name of employer

Address

City

State

Zip: Phone:

Supervisors name:
Supervisors Title:

Job Title and Major Duties

Starting Rate:

Ending Rate: Type:

Reason for leaving

Medical Information

After an offer of employment has been made, but before employment duties begin, Applicants may be required to undergo a physical and/or medical examination at Company expense by a Company selected physician, with the offer of employment conditioned on the result of such examination. Employees, at any time during the course of their employment, may be required to undergo a medical examination at Company expense and by a Company-selected physician.

* I hereby authorize the physician conducting the examination and any laboratory facility testing any specimen obtained, to disclose the results of the examination and/or laboratory tests to the Company. Yes No

* Are you able to perform the essential functions of this job with or without accommodation? Yes No

Military Service

Branch of service in which you served/are serving:
Service dates:
From: To: Pay grade:
Civilian equivalent of military
occupational specialty (MOS) :

Leadership Activities/Honors/Recognition

Include honors, awards, and recognition, you received by community service organizations, schools, sports,
music, arts, science, work, and professional organizations. Exclude the name of any organization if such
information would indicate through character or name, the race, religion color, handicap, marital status, or
ancestry of the membership

List any leadership roles, civic offices or positions you have held
List any honors, awards, or Achievements

Other Information

* Have you ever been convicted of a crime which would have a substantial relationship to the functions and responsibilities of the position for which you are applying? Yes No

References
(Do not use relatives)

Reference #1
*Name	*Phone
*Address
*City	State Zip
*Relationship	Other (write in)
Reference #2
*Name	*Phone
*Address
*City	State Zip
*Relationship	Other (write in)
Reference #3
*Name	*Phone
*Address
*City	State Zip
*Relationship	Other (write in)

Company Policy Regarding Substance Abuse

It is Sure Save's intent to provide and maintain a safe and healthful environment for it's employees, customers, clients, and the general public. As such, the company expects it's employees to report to work free of any form of illegal or unauthorized drugs.
Accordingly, the company's substance abuse policy requires all applicants to undergo drug testing as a condition for employment. Applicants will be required to voluntarily submit to a urinalysis test at a certified laboratory of the company's choosing.
This policy will be strictly enforced for the safety of all.
NO EXCEPTIONS WILL BE MADE

Thank you for considering Sure Save Super Market, Ltd., as your prospective employer. We normally contact our candidates within two weeks from the date application is submitted. If you are not contacted within that time period, your application will be kept on file for a period of six (6) months for future recruitments.

NOTE: If offered employment, you will be required to submit documentation as required by the 1986 Immigration Reform and Control Act.

By submitting this application, I authorize Sure Save Super Market, Ltd. to investigate all statements contained herein. I affirm that all statements are correct to the best of my knowledge and that any misrepresentation or omission of facts is cause for dismissal. This application is not a contract and cannot create a contract. I also understand that my employment is "at will" and can be terminated by either party, with or without cause and with or without notice. I authorize the Company to verify all references and information provided by me in this application, and release the Company, any person or company responding to any reference and/or information from any claim or liability regarding any information or opinions supplied.

I agree to above statement.
* Please enter today's dateMM-DD-YYYY

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