Online Employment Application An Equal Opportunity Employer
North State Grocery is committed to providing a healthy and productive environment for both its employees and customers. Accordingly, all applicants are advised that North State Grocery has adopted a non-smoking policyand that all stores and offices are smoke free.
Personal Information
* indicates a required field
Location Applied For Choose One Alturas, West 12th Street Anderson, Warehouse Auburn, Combie Road Chester, Main Street Colusa, Bridge Street Cool Corning, Solano Street Cottonwood, Gas Point Road Cottonwood, Headquarters Gridley, Washington Street Magalia, Lakeridge Circle Marysville, Covillaud Street Meadow Vista, Placer Hills Road Orland, Walker Street Palo Cedro, Deschutes Road Paradise, Skyway Penn Valley, Pleaseant Valley Placerville, Mt. Aukum Road Quincy, Main Street Red Buluff, Cedar St Redding, Hartnell Avenue Redding, Placer Street Redding, Westside Road Willows, Tehema Street *
First Name Middle Name * Last Name * Social Security Number * must be formatted as 123-45-6789
Street Address * City State Zip * CA NV OR AZ WA * * Phone Number * must be formatted as 123-456-7890 Email Address
Do you have any relatives working for Holiday? No Yes If you answered yes to the above question, please indicate name and relationship
Have you previously been employed by Holiday Quality Foods? No Yes If you answered yes to the above question, please indicate when and what location
Are you at least 18 years old? Choose One No Yes * If you answered no to the above question, can you submit a work permit if hired? Choose One No Yes *
If hired can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country? Choose One No Yes * (proof of U.S. citizenship or immigration status will be required if hired)
How long do you intend to work for Holiday Quality Foods? Choose One 0-3 Months 4-6 Months 7-9 Months 10-12 Months 1-2 Years 2+ Years *
Have you ever been convicted of a felony? Choose One No Yes * If you answered yes to the above question, please indicate when and for what *
Are you currently the subject of any pending criminal charges? Choose One No Yes * If you answered yes to the above question, how will this affect your availability? (Note: No applicant will be denied employment solely on the grounds of a conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances, and the relevance of the offense to the position(s) may, however, be considered)
Employment Interests
Position(s) applying for * Full Time Part Time (If you are applying for a retail hourly position, please keep in mind that the availability of hours may vary)
Date you can begin work? *
Rate of pay expected weekly? *
Are you willing to work rotating shifts and nights and/or weekends? Yes No If not, please explain why:
Do you have any interest in a management position? No Yes If you answered yes to the above question, please indicate what departments
Are you able to perform all job duties and functions of the job for which you are applying? Choose One Yes No * If no, please describe the job duties and functions that cannot be performed and the accommodations you are requesting: (Note: The Company complies with State and Federal laws regarding "reasonable accommodations" that may be necessary for eligible applicants and employees to perform essential functions; however, the failure to advise the Company of necessary job function with or without a reasonable accommodation may be considered misrepresentation. As a matter of Company policy, any such misrepresentations may be the basis for terminating any employment offered.)
If hired would you have a reliable means of transportation to and from work? Yes No
Education, Training and Experience
Have you graduated High School? No Not Yet Yes High School name and address
Did you attend college? No Yes Degree(s) earned If so, please indicate the college name and address
Did you attend a vocational / business school? No Yes Degree(s)/Certificate(s) earned If so, please indicate the college name and address
Please note any other experience, training, qualifications, or skills which you feel make you especially suited for work at Holiday Quality Foods
What is the number one reason you shop where you do? Select One Selection Service Quality Price *
Why would you like to work for Holiday Quality Foods? *
Describe a specific situation where you have provided excellent customer service and why was this effective?
Employment History Please list below all present and past employment starting with your most recent employer (10 years is sufficient)
Most Recent Employment
1: From To Name and Address of Employer - Type of Business Weekly Pay Starting Ending Reason for leaving Position / Duties Performed Supervisors Name Supervisors Phone Number May we contact Yes No
2: From To Name and Address of Employer - Type of Business Weekly Pay Starting Ending Reason for leaving Position / Duties Performed Supervisors Name Supervisors Phone Number May we contact Yes No
3: From To Name and Address of Employer - Type of Business Weekly Pay Starting Ending Reason for leaving Position / Duties Performed Supervisors Name Supervisors Phone Number May we contact Yes No
4: From To Name and Address of Employer - Type of Business Weekly Pay Starting Ending Reason for leaving Position / Duties Performed Supervisors Name Supervisors Phone Number May we contact Yes No
Professional References Please provide the names of three professional references, whom you have known at least one year
1: Name Address Phone number Business Number of years acquainted
2: Name Address Phone number Business Number of years acquainted
3: Name Address Phone number Business Number of years acquainted
Please Read and Sign Below Applicant Certification Authorizations and Understandings
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application and that I am not a current user of illegal drugs. I understand that any omission or misstatement of material facts on this application or any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
I hereby authorize Holiday Quality Foods to thoroughly investigate my references, work records, credit background (to include obtaining a credit report), education and other matters related to my suitability for employment and further, authorize my former employer to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation of disclosure.
I understand that nothing contained in the application or conveyed during my interview which may be granted is intended to create an employment contract between me and the company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without notice, at the option of either myself or the company, and that no promised or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the company's designated
Important Note: Be advised, along with this application you will be required to sign a disclosure and authorization form enabling Holiday Quality Foods to obtain a consumer report and/or investigative consumer report. In addition, you will be required to submit to a drug screen.
I have read and fully understand the above - Yes *
Date * Typed Name In Full *