Da Vinci's Market Employment Application

* - Required fields

Today's Date:

*Name:

*Address:

*City:

*Zip:

*Phone #:

Social Security # (required before starting)

*Birth Date:

*Age:

* Email Address:

If in school, last grade completed:

Name of school:

If in school, what extra-curricular activites are you involved in?

*Position applying for:
(Hold ctrl button to select multiple items)

*Date Available

*Wage Desired

*Full-time or Part-time

Full-time Part-time Either

Store Hours:
Monday - Thursday, 10:30AM - 10:00PM, Friday 10:30AM - 11:00PM, Saturday 11:00AM - 10:00PM, Sunday 11:00AM - 10:00PM. Indicate times available (Start and end).

Mon.	Tues.	Wed.	Thurs.	Fri.	Sat.	Sun.

*At my requested pay rate, I need to work 5-10, 11 - 20, 21 - 30, 31 - 40, 41+ hours per week to pay my bills/maintain my lifestyle.

*This will be my only job or I have/will have a 2nd/3rd job.

List other places of employment & scheduled hours.

*I have problems with my ankles, knees or back that affect my ability to be on my feet for long periods

*Do you have a valid drivers license?

Drivers license #:

Do you have auto insurance?

Auto insurance policy #:

*I can afford to keep my car in working condition to get me to & from work & do not have to rely upon a ride from someone else.

Job references beginning with most recent

Place of employment:

Managers name:

Position

Business phone:

Wage:

Dates of employment:

Reason for leaving:

Place of employment:

Managers name:

Position

Business phone:

Wage:

Dates of employment:

Reason for leaving:

Place of employment:

Managers name:

Position

Business phone:

Wage:

Dates of employment:

Reason for leaving:

References: List the names of three people, not related to you, whom you have known at least one year.

Name:

Address:

Relationship:

Phone:

Name:

Address:

Relationship:

Phone:

Name:

Address:

Relationship:

Phone:

General Requirements:
All associates must be capable and willing to work Friday or Saturday. Associates will receive discounts on food. All associates under 18 require adult approval for employment. Da Vinci's Market will supply a uniform shirt and/or hat; you will be required to supply your own khaki colored pants or shorts and black or brown belt and shoes. The preferred pants are "Dockers" style pants, no corduroys, no sweat pants, and no baggie leg pants permitted. Shoes need to be black, brown or white, athletic shoes with a non-slip sole is preferred, no open-toed or sandals permitted. No facial jewelry is permitted on the job. Other jewelry is limited to a watch, wedding ring and one pair of stud earrings, no loops or dangling earrings. No unusual colored or dyed hair is permitted.

Authorization:
Please read the following statements carefully before signing this application. Only those applications that are completed in full, signed, and dated are considered valid. If you have any questions regarding this statement, please ask them before signing. I certify that all answers or statements I have made on this application or on my resume or other supplementary materials are true and correct without omissions. I acknowledge that any false statement or misrepresentation on this application or supplementary materials will be cause for refusal to hire or for immediate dismissal from employment at any time during the period of my employment, regardless of when or how discovered.

I authorize Da Vinci's Market to check my motor vehicle record and to investigate any traffic accidents I may have been involved in during the last 3 years and to periodically recheck the motor vehicle record while I am employed. I understand that I must have liability insurance coverage while driving for the company & that the company is not responsible for any damage to my vehicle or any other vehicles involved in any possible incidents. I understand agree to provide the company with proof of my insurance coverage when required.

I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application and authorize any of the persons or organizations referenced in this application to provide the company complete information and records concerning any of the subjects covered by this application.

* Check to acknowledge.

Digital Signature	Type name to electronically sign.
* Applicant Name:		* Date:
Parent Name (if under 18):		Date:

On-Line Application