400 South LLC

AL’S & BARNEY'S SUPERMARKETS - EMPLOYMENT APPLICATION

Please fill out the entire application to be considered for a position with us.

Job Interest

What position are you applying for: *

Cashier
Bagger
Deli
Stocker
Produce
Bakery
Meat
Security
Any
Other

What position are you applying for:

Other position

Length of employment desired *

Length of employment desired

Please check all skills and training that you have which may be important in considering you for employment:

Customer Service
Cashier
Supervision
Janitorial
Floral
Deli
Stock
Computer
Sales
Meat
Management
Bagging
Merchandising
Produce
Purchasing
Maintenance
Baking

Please check all skills and training that you have which may be important in considering you for employment:

Personal Information

Name *

First

Middle

Last

Present Address *

Address Line 1

City

State

Zip Code

Email address *

What store do you want to be considered for? *

Al's Franklin - Michigan City, Indiana
Al's Karwick - Michigan City, Indiana
Al's East - La Porte, Indiana
Barney's - New Buffalo, Michigan

Home Phone *

Wage Desired

Alternate Phone Number

Are you at least 18 years of age? *

If under 18, will be required to submit a work permit. Must be at least 16.

Do you have the legal right to work and to remain in the United States? *

Additional Information

How were you referred to us?

Have you ever applied for a job with Al's Supermarkets or Barney's Market? *

If yes, when/where?

Were you previously employed by Al's Supermarkets or Barney's Market? *

If yes, when/where?

List any relatives who work for Al's Supermarkets or Barney's Market

Are you currently Employed? *

Are you a student? *

Are you on leave of absence? *

Have you ever been discharged from a job? *

Have you been convicted of a felony or misdemeanor, except a minor traffic violation, in the past 7 years? *

(NOTE: A conviction will not necessarily disqualify applicant from employment.) If yes, explain.

Availability

What type of employment are you seeking: (Check each classification you are willing to work.) *

Full-Time
Part-Time
Temporary/Seasonal

Date available to start *

If seasonal or temporary -last date to work

Number of hours you would prefer to work each week? *

Maximum number of hours you can work each week? *

We hire people to work during hours we're closed to the public as well as the time that we are open for business. Open availability is preferred.

Please list any day or time availability restrictions.

Work History

LIST WORK HISTORY BELOW BEGINNING WITH THE CURRENT OR MOST RECENT EMPLOYERS AND MILITARY SERVICE.

Employer Name

Type of work

Start Date

Address

Phone Number

Supervisor

Date of Leaving

City, State, Zip

Why did you leave

Pay at Leaving

Employer Name 2

Type of work

Start Date

Address

Phone Number

Supervisor

Date of Leaving

City, State, Zip

Why did you leave

Pay at Leaving

Employer Name 3

Type of work

Start Date

Address

Phone Number

Supervisor

Date of Leaving

City, State, Zip

Why did you leave

Pay at Leaving

Education

LIST ALL HIGH SCHOOL, COLLEGE, UNIVERSITY OR TECHNICAL TRAINING

YEARS COMPLETED

DEGREE OR CERTIFICATE

Important

This application for employment will not be considered unless fully completed.

APPLICANT'S AGREEMENT AND CERTIFICATION.

READ BEFORE SIGNING

I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I understand that, if employed, falsified statements on the application shall be considered sufficient cause for dismissal. I hereby authorize all my previous employers and persons listed as personal references to furnish any information concerning my personal character, work habits or employment record, and release all such persons from liability for damages incurred as a result of furnishing such information. Lakeshore Foods is hereby authorized to make any investigation of my personal history and financial and credit record through any investigative or credit agencies or bureaus of their choice.

I understand that I may be required to undergo screenings for substance abuse (drugs) as a condition of my employment. I also understand that any contract of employment entered into between myself and Lakeshore Foods (dba Al's Valueland and Barney's) shall be for an indefinite term, and said employment shall be terminable at the will of either party without cause.

Lakeshore Foods is an equal opportunity employer. Our policy is to consider all applicants for employment based on their qualifications and our current job vacancies. Applicants are considered without regard to race, color, religion, sex, national origin, age or disability

Applicant's Signature *

Date *

Al’s & Barney’s Supermarkets

AL’S & BARNEY'S SUPERMARKETS - EMPLOYMENT APPLICATION

Job Interest

Personal Information

Availability

Work History

Education

Important