This form may be given to agencies, employers and/or schools you have attended for authorization to release information on your employment, academic history or driving record to I understand that this authorization applies whether I am a current employee or a candidate for employment. to seek and/or verify specific information about my background. This document authorizes Houchens Food Group, Inc. I hereby certify that the above information is true and correct and that if I am employed, any false information contained on this Application Questionnaire shall be grounds for the termination of my employment. I understand that this Application Questionnaire is a part of the Application for Employment for the position which I am applying. What days and hours are you available to work? Would you be willing to take an assignment to another local store? _ Yes _ Noġ1. Have you had an alcohol license revoked within the last two years? _ Yes _ No _ N/Aġ0. Have you been convicted of any felony or twice convicted of an misdemeanor involving alcohol related offenses within the last two years? _ Yes _ No _ N/Aĩ. Do you object to selling tobacco products? _ Yes _ No _ N/AĨ. Do you object to working holidays? _ Yes _ Noħ. Do you object to working weekends? _ Yes _ NoĦ. Do you object to working nights? _ Yes _ Noĥ. or in a Houchens Markets, IGA, or Save-A-Lot Food Stores orįoodland or Piggly Wiggly or Sonic, or Shell, or Pan Osten, or Buehlers Buy Low, or Scot Markets orĪdams & Sullivan operated by Houchens Food Group?Ĥ. Foods Stores, Inc., Southern Recycling, Inc., Center of Insurance, Inc., Are you at least 18 years of age? _ Yes _ Noģ. You will not be allowed to start work until you provide verification.Ģ. If not, your application cannot be processed. Can you submit verification of your eligibility to work in the United States? _ Yes _No INSTRUCTIONS: Please answer all of the questions below.ġ. Test Administered Raw Score Rating Analysis and Comments does not and will not in the future constitute or establish a contractual or other obligation to continue my employment. I further understand and agree that the development and dissemination of policies, procedures, handbooks or other literature by Houchens I understand that my employment can be terminated at any time, with or without cause, at the discretion of either Houchens Industries, Inc. If employed, I agree to comply with all policies, procedures and conditions of Houchens Industries, Inc. from any and all liability in connection with the investigation of my background. I hereby release former employers, educational institutions, law enforcement agencies, credit agencies and all other persons or legal entities from any and all liability in responding to inquiries during the investigation of my background and further release Houchens Industries, and its agents to conduct a background investigation of my personal, employment, criminal, and cred- it/financial histories as well as other matters in arriving at an employment decision. If employed, any misstatement or omission of fact on this Application for Employment may result in my dismissal. The information provided in this Application for Employment is true, correct, and complete. Van Meter Insurance, Priceless Foods, Priceless IGA, Subway, Derby’s Pizza & Subs, Taco Del Mar, Hank’s Market and Ace Hardware? Yes No Scot Mkts, Shell and Pan Osten, Sonic Drive-In, Whites Fresh Foods, Subway, Scotty’s, IGA, Crossroads IGA, IGA Express, American Sun Systems,Ĭohen’s Fashion Optical, Employers Risk Services, Food Giant, Four Seasons, Hilliard Lyons, Hitcents, Stephens Pipe & Steel, Tampico, T S Trucking, Stores, Stewart & Richey Construction, Southern Recycling, Center of Insurance, Foodland, Piggly Wiggly, Adams and Sullivan, Buehlers Buy Low, which owns and operates Houchens Markets, Jr. Have you ever been previously employed by Houchens Industries, Inc. What was your previous address? How long at your present address? _ (A conviction record will not necessarily be a bar to employment) Have you been convicted of a crime in the past ten years? Yes No If not, employment is subject to age verification. does not discriminate on the basis of race, color, national origin, religion, sex, age, disability or military status.ĭid you serve in the Armed Forces? If “Yes” what Branch? MEMBERSHIP IN PROFESSIONAL OR CIVIC ORGANIZATIONS School Name & Location of School Study Completed Graduate Diploma Other special training or skills (languages, machine operations, etc.) Are you legally eligible for employment in the United States? When will you be available to begin work?
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