THE MARKET ON BROADWAY

Position(s) applied for: *

Date of application: *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone Number *

Cell Phone Number *

Name and Address of Last Employer *

Dates Employed (From Month/Year To Month/Year) *

Supervisor and Contact Number *

Job Title & Duties *

Reason For Leaving *

Name and Address of Previous Employer *

Dates Employed (From Month/Year To Month/Year) *

Supervisor and Contact Number *

Job Title & Duties *

Reason For Leaving *

Name and Address of Previous Employer *

Dates Employed (From Month/Year To Month/Year) *

Supervisor and Contact Number *

Job Title & Duties *

Reason For Leaving *

High School: *

Years Completed *

Diploma/Degree *

Yes No

Course of Study or Major *

Describe Specialized Training or Skills *

College/University: *

Years Completed *

Diploma/Degree *

Yes No

Course of Study or Major *

Describe Specialized Training or Skills *

Trade, Correspondence, Other: *

Years Completed *

Diploma/Degree *

Yes No

Course of Study or Major *

Describe Specialized Training or Skills *

Name & Title *

Business Relationship *

Contact Phone or Email *

Name & Title *

Business Relationship *

Contact Phone or Email *

1. On what date are you available to begin work? *

2. Days/Hours available to work? *

3. Are you available to work: *

Full-time Part-time

4. If hired, would you have a reliable means of transportation to and from work? *

Yes No

5. Can you travel if the position requires it? *

Yes No

6. Are you at least 18 years old? *

Yes No

7. If hired, can you present evidence of your identity and legal right to live and work in this country? *

Yes No

8. Are you able to perform the essential job functions of the job for which you are applying with or without reasonable accommodations? *

Yes No

INITIAL *

I hereby certify that the information contained in the employment application I submit to Market on Broadway is true and complete to the best of my knowledge. I understand that material omissions or falsification of this application in any detail may result in my disqualification from consideration for employment or for dismissal from employment.

INITIAL *

I also understand that my employment is subject to a satisfactory check of references. I give Market on Broadway the right to investigate the information given and to secure additional information if necessary. I authorize my previous employers, educational institutions and all other individuals and organizations listed in this application form to give information about my employment, work habits and character.

INITIAL *

I agree that Market on Broadway and my previous employers, educational institutions and all other individuals and organizations listed in this application will not be held liable in any respect if an employment offer is not made, is withdrawn, or my employment is terminated because of misrepresentations or omission of requested information.

INITIAL *

I understand that upon offer and acceptance of a position with Market on Broadway I will be required to immediately furnish documentation establishing my identity and eligibility to be legally employed in the United States.

INITIAL *

I understand that Market on Broadway is in no way obligated to provide employment and also that I am in no way obligated to accept employment, if offered. This application does not bind either party, and the statements contained herein do not constitute and should not be interpreted to constitute any sort of contract of employment for a specific period of time.

INITIAL *

I understand that employment at Market on Broadway (“the Company”) is employment at-will. Employment at-will may be terminated at the will of either me or the Company. Employment may be terminated with or without cause at any time by me or by the Company. Terms and conditions of employment with the Company may be modified at the sole discretion of the Company with or without cause and with or without notice.

I also understand that other than the Director of the Company, no one has the authority to make any agreement for employment other than for employment at-will or to make any agreement limiting the Company’s discretion to modify terms and conditions of employment. Only the President has the authority to make any such agreement and then only in writing.

I understand that no implied contract concerning any employment-related decision or term of condition of employment can be established by any other statement, conduct, policy or practice. Examples of the types of terms and conditions of employment which are within the sole discretion of the Company include, but are not limited to, the following: Promotion; demotion; transfers; hiring decisions; compensation; benefits; qualifications; discipline; layoff or recall; rules; hours and schedules; work assignments; job duties and responsibilities; production standards; subcontracting; reduction, cessation or expansion of operations; sale, relocation, merger or consolidation or operations; determinations concerning the use of equipment, methods or facilities; or any other terms and conditions that the Company may determine to be necessary for the safe, efficient and economic operation of its business.

Name *

First

Last

Date: *

The Market on Broadway Application for Employment

Employment Experience

Education

Business/Professional References

General Information

APPLICANT STATEMENT AND AGREEMENT

Employment At-Will

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