APPLICATION FOR EMPLOYMENT

Equal Opportunity Employer

Martin’s Super Markets does not discriminate in hiring or employment on the basis of age, race, sex, religion, color,
national origin, disability, or any other legally protected status in accordance with applicable local, state, and federal law.
No question on this application is intended to be used for such discrimination. We provide a smoke free working environment.
Please answer each question completely. Please print clearly and carefully.

Name ____________________________________________ Phone No. ( )________________

Address ________________________________________________________________________
Number & Street City State Zip Code

Other names under which employed ______________________________

State age if under 18: _________

Have you ever worked at any Martin’s Super Markets location? ___ Yes ___ No

If yes, when: ______________ Where:__________________ Position: _______________________

Reason for leaving: ________________________________________________________________

Are you legally eligible to work in the United States? ___ Yes ___ No

PLACEMENT INFORMATION
Mark the position(s) that interest you:
__ Bakery Clerk __ Floral Clerk __ Stock Clerk __ Janitorial
__ Deli Clerk __ Salad Bar Clerk __ Night Stock (3rd Shift) If applying at Central Bakery:
__ Cashier __ Meat Wrapper __ Paw Mart Clerk __ Baker
__ Service Clerk __ Meat Cutter __ Pharmacy Tech __ Packager
__ Produce Clerk __ Meat Clerk __ Coffee Kiosk __ Cake Decorator
List your skills related to the position(s) you are seeking: ______________________________________
___________________________________________________________________________________________

What is the earliest and latest time you can work each day:
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Earliest Time
Latest Time

Would you prefer: ___ Part Time ___ Full Time

Date Available to begin work: ____________________________ Expected Hourly Rate:____________________

Did you graduate from High School? ___ Yes ___ No ___ Still Attending
Are you currently a full time student? ___ Yes ___ No If yes, anticipated graduation date: ________
School Name and Location Major Study H.S. Diploma/Degree Earned
High School

College
Trade/Business
Graduate School

Specific training or education which will assist you in the job for which you are applying: ___________________
___________________________________________________________________________________________

EMPLOYMENT HISTORY
Mo/Yr Mo/Yr Employer Position Wage Reason for Leaving
From To Name ________________________________
Address ______________________________
City ____________ State______ Zip _______
Phone ( ) ___________________________
Supervisor’s Name______________________
From To Name ________________________________
Address ______________________________
City ____________ State______ Zip _______
Phone ( ) ___________________________
Supervisor’s Name______________________
From To Name ________________________________
Address ______________________________
City ____________ State______ Zip _______
Phone ( ) ___________________________
Supervisor’s Name______________________
May we contact your present employer? ___ Yes ___ No
May we contact your previous employer? ___ Yes ___ No

REFERRAL SOURCE
___ Walk-In ___ Friend/Relative ___ Newspaper/Advertisement
___ Employee ___ School/Job Fair ___ Other _________________
I certify that the information I have provided in this application and/or during the interview process is true to the best of my knowledge. I understand
that any misrepresentation, stated or implied, may result in the denial of employment or in termination if I am hired. I understand and agree that all
information furnished in this application may be verified by Martin’s Super Markets or its authorized representative. I further understand that, if I am
hired, I am required to abide by all of Martin’s Super Markets’ rules, policies, and procedures. I also understand that Martin’s Super Markets’ rules,
policies and procedures can and may be changed or modified without notice. I also understand that Martin’s Super Markets is not obligated to provide
employment to me and that I am not obligated to accept employment. Nothing in this application or in any prior oral or written statements made by
Martin’s Super Markets or its authorized representative is intended to create any employment contract or any rights in the nature of an employment
contract. This application does not bind either me or Martin’s Super Markets for a specific period of time regarding employment. Any applicant who
provides unrequested information will not be considered.

_____________________________________________ ______________________________________
Signature Date

THIS APPLICATION WILL REMAIN ACTIVE FOR 60 DAYS 02/15