Name *

First Name

Last Name

Are you over 18 years of age? *

Yes

No

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Referred by

First Name

Last Name

Which type of employment are you seeking?

Part-time only

Full-time only

Part-time or Full-time

Temporary

Date You Can Start *

MM

DD

YYYY

Are you employed now? *

Yes

No

If so, may we inquire of your present employer? *

Yes

No

Are you legally authorized to work in the U.S.? *

Yes

No

Have you ever applied to Ayer Shop 'n Save before? *

Yes

No

Have you ever worked for Ayer Shop 'n Save before? *

Yes

No

Name of Last Supervisor at Ayer Shop 'n Save

First Name

Last Name

How did you find out about Ayer Shop 'n Save? *

Please select all that apply.

Employment Agency

State Employment office

Newspaper Advertisement

College Placement Service

Friend

Walk-In

Online Ad

Website

Other

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Did you graduate?

Yes

No

Still attending

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Did you graduate?

Yes

No

Still attending

Have you ever served in the U.S. Armed Forces? *

Yes

No

Discharge Date

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Starting Date

MM

DD

YYYY

Leaving Date

MM

DD

YYYY

May we contact your supervisor?

Yes

No

Name of Supervisor

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Starting Date

MM

DD

YYYY

Leaving Date

MM

DD

YYYY

May we contact your supervisor?

Yes

No

Supervisor Name

First Name

Last Name

Phone

(###)

###

####

1. Reference Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

2. Reference Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

3. Reference Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####