PILGRIMS MARKET EMPLOYMENT APPLICATION OUR MISSION STATEMENT: TO OPERATE A FINANCIALLY SUSTAINABLE AND PRINCIPLED COMPANY; TO SERVE, EMPOWER AND
DELIGHT OUR HEALTH-SEEKING CUSTOMERS AND TO CREATE A CHALLENGING, EMPOWERING AND REWARDING WORK
ENVIRONMENT FOR OUR TEAM MEMBERS, LEADERS AND ADVISORS THAT OVER TIME WILL PROVIDE OPPORTUNITIES FOR
PERSONAL AND PROFESSIONAL ADVANCEMENT.
PLEASE FILL OUT APPLICATION COMPLETELY Date of Application __________________________________E-mail Address ________________________________________________________
Full Name_____________________________________________________________________ Phone Number______________________________
No. & Street_______________________________________________ City_________________________ State________ Zip Code_____________
POSITION FOR WHICH YOU ARE APPLYING____________________________________________________________________________________
Date you can start_________________________________________ How did you find this opening? _____________________________________
Have you ever applied to or worked for Pilgrims Market before? __ Yes __ No
If yes, when?______________________________________________________________________________________________________________
Do you have friends or relatives working for Pilgrims Market?___ Yes ____ No
If yes, state name(s) and relationships:_______________________________________________________________________________________
We may refuse to hire relatives of present team members if doing so could result in actual or potential problems in supervision, security,
safety, or morale, or if doing so could create conflicts of interest.
If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country? Yes____ No____
Are you at least 18 years old? __ Yes __ No (If under 18, hire is subject to verification that you are of minimum legal age.)
Your availability: Circle all that apply: Weekdays
Weekends
Weekday Evenings
Weekend Evenings
What is your wage requirement? $_____________
Do you have any commitments to another employer that might affect your employment with us?___ Yes ___ No
If yes, please describe _____________________________________________________________________________________________________
Do you have any other commitments (school, training programs, etc.) that would prevent you from working at specific times? ___Yes___No
If yes, please give times you are NOT available_________________________________________________________________________________
Do you have any future plans or commitments that might interfere with your schedule at Pilgrims Market? ____ Yes ____ No
If yes, please describe______________________________________________________________________________________________________
What is the maximum number of hours per week you would work?___________________________ Minimum hours? _______________________
What other areas of the store would you be interested in working other than the one for which you are currently applying? _______________
List below all present and past employment starting with your most recent employer (last five years is sufficient). Account for all
periods of unemployment. You must complete this section even if attaching a resume.
__________________________________________________________________________________________
Current/Most Recent Employer
Hire Date
End Date
_________________________________________________________________________________________________________________________
Address & Street
City
State
Zip Code
_________________________________________________________________________________________________________________________
Your position
Your duties
______________________________________________________________________________$_____________________$____________________
Your Supervisor’s Name
Starting Pay
Ending Pay
______________________________________________________________________________YES___________________NO__________________
Reason for Leaving
May we contact this employer for a reference?
__________________________________________________________________________________________
Current/Most Recent Employer
Hire Date
End Date
_________________________________________________________________________________________________________________________
Address & Street
City
State
Zip Code
_________________________________________________________________________________________________________________________
Your position
Your duties
______________________________________________________________________________$_____________________$____________________
Your Supervisor’s Name
Starting Pay
Ending Pay
______________________________________________________________________________YES___________________NO__________________
Reason for Leaving
May we contact this employer for a reference?
__________________________________________________________________________________________
Current/Most Recent Employer
Hire Date
End Date
_________________________________________________________________________________________________________________________
Address & Street
City
State
Zip Code
_________________________________________________________________________________________________________________________
Your position
Your duties
______________________________________________________________________________$_____________________$____________________
Your Supervisor’s Name
Starting Pay
Ending Pay
______________________________________________________________________________YES___________________NO__________________
Reason for Leaving
May we contact this employer for a reference?
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?
____ Yes ____ No
If no, describe the functions that cannot be performed _________________________________________________________________________
_________________________________________________________________________________________________________________________
Have you ever been convicted of a criminal offense (felony or serious misdemeanor)? _____ Yes _____ No
If yes, state nature of the crime(s), when and where convicted, and disposition of the case __________________________________________
_________________________________________________________________________________________________________________________
Do you speak, write or understand any foreign languages? __ Yes __ No If yes, please describe:________________________________________
_________________________________________________________________________________________________________________________
When we check your references, what do you think would be named as your greatest strength? _______________________________________
_________________________________________________________________________________________________________________________
…As your greatest weakness or area for growth? _______________________________________________________________________________
_________________________________________________________________________________________________________________________
If you have ever been a customer at Pilgrims Market, describe what you enjoyed most about your experience: __________________________
_________________________________________________________________________________________________________________________
Please describe how your previous work experience has prepared you for a position with Pilgrims Market: ______________________________
_________________________________________________________________________________________________________________________
The pace is often very fast at Pilgrims Market and situations can be challenging and/or stressful. Why do you believe you can work well
under these conditions? ____________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
What two qualities make you an outstanding candidate for this position? __________________________________________________________
_________________________________________________________________________________________________________________________
Please provide 3 business references, preferably supervisors or previous employers. Please verify in advance that these numbers are
accurate.
_________________________________________________________________________
(_________)______________________
Name
Phone Number
Relationship
_________________________________________________________________________
(_________)______________________
Name
Phone Number
Relationship
_________________________________________________________________________
(_________)______________________
Name
Phone Number
Relationship
Please Read Carefully, Initial Each Paragraph and Sign Below
______ 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.
______ I understand that any omission or misstatement of material fact on this application or on 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 Pilgrims Market to thoroughly investigate my references, work record, education and other matters related to my
suitability for employment and, further, authorize the references I have listed 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 Pilgrims
Market, 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 or disclosure.
_______ I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my
employment, if hired, is intended to create an employment contract between me and Pilgrims Market. 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 prior
notice, at the option of either myself or Pilgrims Market, and that no promises or representations contrary to the foregoing are binding on
the company unless made in writing and signed by me and the designated Pilgrims Market representative.
_________________________________________________________________________________________________________
Applicant's Signature
Date