Hippo's

Job(s) for Which You Are Applying:
Date of Application:
First Available Date to Begin Work:

Contact Information
Last Name:
First Name:
Middle Initial:
Address::
City:
State:;
Zip Code:
Telephone:
Telephone Type
E-mail Address:	(E-mail)

General Information
Can you show proof of your eligibility to work in the United States?
Are you the minimum working age of 18-years-old or older?
The Hippo's Grocery and Deli building and grounds are smoke-free environments. Can you adhere to this policy?
Are you a Hippo's Grocery and Deli volunteer?
Have you ever been employed before by Hippo's Grocery and Deli?
Do you have friends or relatives already employed by Hippo's Grocery and Deli?
Do you have any physical, mental or medical conditions that would interfere with your ability to perform the job for which you are applying?
Are you currently charged with or have you ever been convicted of any crime, or has your driver's license been suspended?
Have you ever been suspended or discharged from employment?

Education, Beginning With Most Recent
Year(s) School Degree and Major Did You Graduate?


Education, Beginning With Most Recent
Job Title:
Employed From:
To:
Responsibilities:

Reason for Leaving:
Employer:
Address:
Telephone:
Supervisor:
May Hippo's Grocery and Deli Contact This Employer?

Education, Beginning With Most Recent
Job Title:
Employed From:
To:
Responsibilities:

Reason for Leaving:
Employer:
Address:
Telephone:
Supervisor:
May Hippo's Grocery and Deli Contact This Employer?

Education, Beginning With Most Recent
Job Title:
Employed From:
To:
Responsibilities:

Reason for Leaving:
Employer:
Address:
Telephone:
Supervisor:
May Hippo's Grocery and Deli Contact This Employer?

Special Skills
Describe special skills, experiences, qualifications or accomplishments.


Describe your computer proficiency. List specific software and your level of experience using it.


References Provide three non-family references and indicate their relationship to you (e.g., employer, teacher, should directly mail a letter of reference to Hippo's Grocery and Deli at the address provided on page 4.

Name:
Relationship to You:
Address:
Daytime Telephone:
E-mail:

Name:
Relationship to You:
Address:
Daytime Telephone:
E-mail:

Name:
Relationship to You:
Address:
Daytime Telephone:
E-mail:

Statement of Understanding I certify that the statements made in this application are correct and complete to the best of my knowledge. I understand that false, omitted or misleading information may result in rejection of this application or termination of subsequent employment. With the possible exception as indicated on page 2 of this application, I understand that Hippo's Grocery and Deli may investigate all statements made on my application and release from liability former employers, institutions or persons providing such information to Hippo's Grocery and Deli. If accepted for employment with Hippo's Grocery and Deli, I agree to abide by all of its rules, regulations, policies and procedures. If employed, I understand that I may terminate my employment at any time without notice or cause, and that Hippo's Grocery and Deli may terminate or modify the employment relationship at any time without prior notice or cause. If employed, I understand that my employment is for no definite period of time and if terminated, Hippo's Grocery and Deli is liable only for wages and benefits earned as of the date of termination.

Your Name:
Date:

Hippo's Grocery and Deli is an equal opportunity employer and considers applicants for all positions without regard to race, religion, gender, national origin, age, ancestry, sexual orientation, marital or veteran status, disability or any other legally protected status.