Working at Weiland’s … please read this first:
Working at Weiland’s means that you agree to make a serious commitment to providing great customer
service, learning about great food, and bringing positive energy to work every day. We know not
everyone will care as much about these things as we do. If Weiland’s isn’t for you, we wish you the best
in your job search. If you think this is the place for you, we’d love for you to fill out this application.
Two important notes: Please make sure your application is complete, including your references; we won’t
schedule an interview with you if your application isn’t complete. Also, we are a Drug-Free Workplace,
and you will be tested for drugs shortly after you’re hired (our test is cheat-proof).
Today’s date ______________
Name _________________________________________________
Street address _______________________________________________
City _____________________ State _______ ZIP __________
Telephone ___________________________
Email: ________________________________________
Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? (You will be
required to provide documentation.)  Yes  No
Do you want to work:  Full-time  Part-time
Please mark the times you are available to work:
Mon
Tues
Wed
Thurs
Fri
Sat
Sun
AM
PM
Are you at least 18 years old? (If you’re under age 18, you can still apply as a bagger.)  Yes  No
Have you ever been convicted of a criminal offense?  Yes  No
If yes, please describe the offense:
_____________________________________________________________________________________
_____________________________________________________________________________________
Are you applying for a specific job opening? ________________________________________
How were you referred to us? _________________________________________________
Have you ever applied at Weiland’s?  Yes  No
If yes, when? _______________
Have you ever been employed by Weiland’s?  Yes  No
What date can you start? ________________
What are your pay requirements? _________
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If yes, when? ______________
Education
School Name and Location
Degree/Major
Completed?
High School ________________________________________ __________
 Yes  No
College ___________________________________________
__________
 Yes  No
College ___________________________________________
__________
 Yes  No
Post-College _______________________________________
__________
 Yes  No
Other Training ______________________________________ __________
 Yes  No
Are you planning to continue your education?  Yes  No
If yes, where and what courses of study?
______________________________________________________________________________
Please list any other training, experience, skills, or other qualifications, including hobbies, which we
should consider while evaluating your application:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Do you smoke?  Yes  No If you answered no, when was the last date you smoked? ____________
Have you ever been disciplined for violating workplace policies forbidding the use of alcohol or tobacco
products?  Yes  No
If yes, please describe:
_____________________________________________________________________________________
_____________________________________________________________________________________
Do you use illegal drugs?  Yes  No
How many days of work did you miss last year? _________
Employment History
Please list your current or most recent employer first. Please use the back of this page or another sheet of
paper if necessary. “See resume” is not an option; we need the information here, too.
Company Name _______________________________________________________________________
Address _______________________________________Telephone ______________________
Date Started ____________ Starting Wage ____________ Starting Position _______________
Date Ended _____________ Ending Wage ____________ Ending Position ________________
Name of Supervisor and Telephone Number _________________________________________________
May we contact?  Yes  No
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If no, why not? ____________________________________________
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Duties _______________________________________________________________________________
Why did you decide to leave (if you’re still working at this job, why are you looking for a new job)?
_____________________________________________________________________________________
Company Name _______________________________________________________________________
Address ________________________________________ Telephone ______________________
Date Started ____________ Starting Wage ____________ Starting Position _______________
Date Ended _____________ Ending Wage ____________ Ending Position ________________
Name of Supervisor and Telephone Number _________________________________________________
May we contact?  Yes  No
If no, why not? ____________________________________________
Duties _______________________________________________________________________________
Why did you decide to leave? ____________________________________________________________
Company Name _______________________________________________________________________
Address ________________________________________ Telephone ______________________
Date Started ____________ Starting Wage ____________ Starting Position _______________
Date Ended _____________ Ending Wage ____________ Ending Position ________________
Name of Supervisor and Telephone Number _________________________________________________
May we contact?  Yes  No
If no, why not? ____________________________________________
Duties _______________________________________________________________________________
Why did you decide to leave? ____________________________________________________________
Company Name _______________________________________________________________________
Address ________________________________________ Telephone ______________________
Date Started ____________ Starting Wage ____________ Starting Position _______________
Date Ended _____________ Ending Wage ____________ Ending Position ________________
Name of Supervisor and Telephone Number _________________________________________________
May we contact?  Yes  No
If no, why not? ____________________________________________
Duties _______________________________________________________________________________
Why did you decide to leave? ____________________________________________________________
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Please answer the following true/false questions:
I enjoy seeing the sunrise.
 True
 False
I can work weekends.
 True
 False
I enjoy working in the evenings.
 True
 False
I enjoy working in the mornings.
 True
False
I get along well with co-workers.
 True
 False
I don’t mind working around the holidays.
 True
 False
I can work many hours in December.
 True
 False
I love to eat great bread.
 True
 False
I bring positive energy to work every day.
 True
 False
I enjoy providing great customer service.
 True
 False
I can lift at least 25 pounds.
 True
 False
I can be on my feet for an 8-hour shift.
 True
 False
I pay attention to details.
 True
 False
I have good people skills.
 True
 False
Please answer the following questions:
Weiland’s is a high-volume business, with high expectations for customer service, and a work day that
can be long and stress-filled. What makes you believe you can perform well and excel here?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Weiland’s is a very service-oriented business. What does good service mean to you?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
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Describe a real incident in which you were treated rudely as a customer. How would you have handled it
differently if you had been in the other person’s shoes?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
If you have ever shopped at Weiland’s, please describe what you enjoyed most about experience.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
What experience and knowledge do you expect to gain from working at Weiland’s?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
When we talk with your references, what do you think they will name as your greatest strength and your
greatest weakness?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
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References
List three references (not related to you) who have known you for more than one year.
Name ___________________________ Phone ____________________ Years Known______
Address ____________________________________________________________________
Name ___________________________ Phone ____________________ Years Known______
Address ____________________________________________________________________
Name ___________________________ Phone ____________________ Years Known______
Address _____________________________________________________________________
Please Read Before Signing:
I certify that all information provided by me on this application is true and complete to the best of my
knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of this application.
I authorize my previous employers, schools, or persons listed as references to give any information
regarding employment or educational record. I agree that this company and my previous employers will
not be held liable in any respect if a job offer is not extended, or is withdrawn, or employment is
terminated because of false statements, omissions, or answers made by myself on this application. In the
event of any employment with this company, I will comply with all rules and regulations as set by the
company in any communication distributed to the employees.
In compliance with the Immigration Reform and Control Act of 1986, I understand that I am required to
provide approved documentation to the company that verifies my right to work in the United States on the
first day of employment. I have received from the company a list of the approved documents that are
required.
I understand that employment at this company is “at will,” which means that either I or this company can
terminate the employment relationship at any time, with or without prior notice, and for any reason not
prohibited by statute. All employment is continued on that basis. I hereby acknowledge that I have read
and understand the above statements.
Signature _______________________________________________ Date________________
Our policy is to provide equal employment opportunity to all qualified persons without regard to race,
creed, color, religious belief, sex, age, national origin, ancestry, physical or mental disability, or veteran
status.
Updated 04/18/13
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