Friedman's BiLo Supermarket Employment Form

EMPLOYMENT INFORMATION

Name: Address:

City: State: Zip: Phone #:

E-mail:

Have you ever worked at Friedman's Supermarkets before? Yes? No?

If yes, When and Where?

Hours Available for Work:

	Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
From
To

Total Hours Available Per Week:

Are you applying for summer employment only? Yes? No?

SCHOOL MOST RECENTLY ATTENDED
Name		Phone
Are you 18 years or older? Yes No		Last Grade Completed
Graduated? Yes No GED		Sports/Activities
EMPLOYMENT HISTORY		Please List Two Most Recent Jobs
Company		Company
Supervisor		Supervisor
Duties	Dates	Duties	Dates
Phone		Phone

This Company does not discriminate against qualified applicants or employees on the basis of race, creed, national
origin, sex, color, ancestry, pregnancy, age, or other status or condition protected by applicable law. However, we
insist that all of our employees can perform the essential functions of their employment and have the character,
integrity, and general reputation for honesty of a person we would be willing to have represent our Company in its
dealings with customers, suppliers and/or other employees. Accordingly, we insist on complete honesty. ANY
LATER DISCOVERY THAT AN APPLICANT WAS NOT TOTALLY HONEST IN COMPLETING THIS
APPLICATION MAY RESULT IN DISCHARGE.