Employment Application
Thank you for your interest in in.gredients! We appreciate your time.
This application is intended for use in evaluating your qualifcations for employment. in.gredients is an equal opportunity
employer. All qualifed applicants will receive considerations without regard to race, color, religion, sex, national origin, age,
disability, sexual orientation, genetic information, or other characteristics protected by law. In addition to the application,
other assessments, including, but not limited to, interview, job related skill testing, and reference verifcation may be
required prior to employment.
Personal Information
Name:
Date:
Address
(Street, Apt #)
(City, State)
(Zip)
Home Telephone Number
Mobile Telephone Number
Best time to call
E-mail address:
Do you know anyone who currently works, or previously worked for in.gredients?
Yes
No
If yes, who:
Are you eligible to work in the US?
Yes
No
Availability
Ideal number of hours per week:
15
20
25 30
When could you start?
Please indicate the times that you would be available to work below:
Day:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
From...
To...
In the next 6 months, do you expect any change to your availability? If so, please explain:
Do you have a reliable source of transportation?
Yes
No
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Education
Highest level of education completed?
High School (name and location):
University (name and location):
Graduate?
Yes
No
Graduate?
Degree:
Yes
No
Please Describe any additional relevant education or training:
Employment History
Please list chronologically, starting with current or last employer (feel free to attach additional sheets if necessary).
Employer:
Telephone:
Supervisor's name and title:
Wage or salary:
Start:
Address:
Reason for Leaving:
End:
Employment dates:
From:
To:
Job title and duties:
Employer:
Telephone:
Supervisor's name and title:
Wage or salary:
Start:
Address:
Reason for Leaving:
End:
Employment dates:
From:
To:
Job title and duties:
Employer:
Telephone:
Supervisor's name and title:
Wage or salary:
Start:
Address:
May we contact this employer?
Yes
No
If no, explain:
Reason for Leaving:
End:
Employment dates:
From:
May we contact this employer?
Yes
No
If no, explain:
To:
May we contact this employer?
Yes
No
If no, explain:
Job title and duties:
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Questionnaire
What specific experience do you have related to the position you are applying for (retail experience, knowledge of
natural foods, local businesses, sustainability, culinary experience, etc.)?
What does “providing excellent customer service” mean to you?
Please tell us any personal strengths you have that could be utilized at in.gredients. Toot your horn!
Have you ever been convicted of a crime (conviction will not necessarily disqualify an applicant from employment)?
Yes
No
If yes, please explain the nature of the offense and date:
Do you currently have a Food Handler's Certifcation from the City of Austin?
Yes Expiration date:__________________
No
and a TABC sever/seller certifcation?
Yes Expiration date:__________________
No
If hired, you will be required to receive the above certifcations before beginning employment at in.gredients.
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References
Reference 1
Reference 2
Name:
Name:
Relationship
Relationship
Telephone No:
Telephone No:
E-mail:
E-mail:
Job Matching
Please review the following list of work conditions. Rate each one from 1 to 3 according to the scale below.
1 = Undesirable. Cannot or will not do
2 = I don't love it, but I'll do it
3 = Love it and/or excel at it
___Juggling multiple tasks
___Adapting to change
___Handling meat
___Lifting 25lbs or more, frequently
___Washing Dishes
___Cleaning things throughout the day
___Cleaning gross things
___Standing for long periods of time
___Preparing food
___Interacting with customers with
different values than your own
___Continuously learning product
knowledge and sharing with customers ___Working behind a counter
___Providing excellent customer service
___Working for < $10 an hour
___Working for > $10 an hour
___Working in a fast paced environment ___Working under pressure
___Collecting and separating trash and ___Being accountable for money
recyclables
Signature
I certify that I have read and understand this application in its entirety, and that the answers and statements given by me are
true and correct to the best of my knowledge. I understand that any inaccurate or omitted information on the facts called for
in this application may result in rejection of my application, or, if hired, immediate termination of employment.
I understand that nothing contained in the application, conveyed during any interview, or during my employment, if hired, is
intended to create an employment contract between me and IN.GREDIENTS GROCERS -- EAST AUSTIN LP. In addition, I
understand and agree that if I am employed, my employment is for no defnite or determinable period and may be
terminated at any time at the option of either myself or IN.GREDIENTS GROCERS -- EAST AUSTIN LP, and that no
promises or representations contrary to the foregoing are binding on IN.GREDIENTS GROCERS -- EAST AUSTIN LP.
I hereby authorize any and all schools, former employers, references, courts and any others who have information
concerning me to provide such information to IN.GREDIENTS GROCERS -- EAST AUSTIN LP and I release all parties
involved from any and all liability for any and all damage that may result form providing such information.
BY SIGNING BELOW I ACKNOLWEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE
STATEMENTS.
Signed:
Date:
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