Do you know anyone working for the Company? [ ] Yes [ ] No If “Yes”, Who:
MEDICAL AND CRIMINAL CONVICTION INFORMATION:
• After an offer of employment is made, applicants may be required to undergo a physical and/or other medical examination at Company
expense and by a Company-chosen physician. Passing said examinations are a condition of employment.
I authorize the physicians conducting the examinations and any laboratory testing any specimen obtained by the physicians to disclose the
results of the examinations and the laboratory tests to the Company.
• The Company may inquire into and consider any criminal conviction record that you may have after it makes a conditional offer of
employment to you. The Company may withdraw a conditional employment offer if you have a criminal conviction record which bears a
rational relationship to the duties and responsibilities of the position for which you are applying. Any criminal conviction record that is more
than 10 years old or that involves certain Family Court matters will not be considered.
• Do you have a current Tuberculosis Clearance Card? [ ] Yes [ ] No Date last tested:
Name of School
Address Years Attended Degree/Diploma
Company Name: Phone:
Position & Duties:
Reason For Leaving:
Street Address City Zip
Other (Trade School, etc.)
Why would you like to work at Times, Big Save, Fujioka’s Wine Times or Shima’s?__________________________________________________
If you are hired, describe what you feel you can contribute to our Company or Store:_________________________________________________
It is policy of the Company to hire only U.S. citizens and aliens who are authorized to work in the U.S. As a condition of employment, you will be required to
produce original documents establishing your identity and authorization to work and to complete the U.S. Immigration and Naturalization Service’s Form I-9.
I certify that all statements made on this application are true and complete to the best of my knowledge. I understand that my application will not
be considered if it is incomplete. Further, I understand that any misrepresentation or omission will subject me to not being considered for hire
or, if said misrepresentation or omission is discovered after hire then it may result in immediate termination of employment. I hereby, authorize
any investigation of the above or related work experience, education, or reputation information for purposes of consideration of my application for
Notice to previous employers: I also authorize my previous employers to release any and all pertinent employment data to Times Super Market,
Big Save Markets, Fujioka’s Wine Times and Shima’s Market. This data will be used solely in its hiring process.
This application is not a contract and cannot create a contract. I understand that if I am employed by Times, Big Save, Fujioka’s Wine Times or
Shima’s my employment is “at will” and can be terminated at any time, either by myself or the Company, with or without cause or reason and with
or without notice.
Applicant’s Signature Application Date
Thank you for considering for your next job!!
Do you have a reliable means of transportation? [ ] Yes [ ] No