Required fields are indicated by an asterisk*
Personal Information
First Name*
Last Name*
Address*
Address2
City* State* Zip*
SSN --
Email*
Home Phone* () -   ext.
   
Location and Position Desired*
Select a store: Select Position:  
   
Please indicate specific times you would be available for work each day.
Monday Tuesday Wednesday Thursday Friday
Saturday Sunday Best Time to contact  
 
         
Are you 14 or older?    16 or older? 18 or older?
   
Have you ever worked for Hollywood Markets in the past?
Yes No
If yes, please indicate your prior dates of employment:
   
Have you ever been suspended, discharged, or resign in lieu of being discharged from any position?
Yes No
If yes, please explain:
 
Have you ever been convicted of a crime?
Yes No
If yes, please explain:
   
Do you have any felony arrests pending?
Yes No
If yes, please explain:
   
Do you currently have unrestricted authorization to work in the United States?
Yes No
   
High School Education
Name and Location:
Course of Study:
Year Completed:
Diploma Received:
Did you graduate?
Yes No
Currently Attending:
   
College/University Education
Name and Location:
Course of Study:
Diploma Received:
Did you graduate?
Yes No
Currently Attending
   
Employment History
Current/Previous Employer Name:
Phone Number: () -   ext.
Dates of Employment: To
Supervisor:
Position Held:
Brief Description of Duties:
Last Wage:
Reason for Leaving:
   
Current/Previous Employer Name:
Phone Number: () -   ext.
Dates of Employment: To
Supervisor:
Position Held:
Brief Description of Duties:
Last Wage:
Reason for Leaving:
   
Current/Previous Employer Name:
Phone Number: () -   ext.
Dates of Employment: To
Supervisor:
Position Held:
Brief Description of Duties:
Last Wage:
Reason for Leaving:
   
Reference Authorization
I hereby authorize Hollywood Markets to investigate all statements contained in this application, including my criminal background, to contact my previous employers, to contact educational institutions I have attended, and to discuss my employment/educational history with them. I authorize the release of any information concerning my criminal background, employment, and educational history to Hollywood Markets by my former employers and educational institutions. I hereby release Hollywood Markets, and its officers, employees, and agents, and any company representing Hollywood Markets, my current and former employers, and the educational institutions that I have attended, from any and all suits, claims, and demands whatsoever, by law or equity, to which I may become entitled to resulting from the disclosure and discussion of any such information, records, or other documents that pertain to me.

 Please list references below (preferably work references):
Name and Title:
Company, if Applicable:
Phone Number: () -   ext.
Street Address:
City:
State:
Zip:
This person is a:
Supervisor Co-Worker Friend Other
   
Name and Title:
Company, if Applicable:
Phone Number: () -   ext.
Street Address:
City:
State:
Zip:
This person is a:
Supervisor Co-Worker Friend Other
   
Will you submit to a drug test if required?
Yes No
   
Drug/Alcohol Screen Authorization

I acknowledge that remaining free of illegal drug use and complying with Hollywood Markets Drug/Alcohol policy is a condition of my employment. I understand and agree to submit a sample of my urine for chemical testing or other necessary procedures through a medical provider of Hollywood Markets choice as a condition of employment. I understand this analysis will be used to determine the presence, if any, of non-prescribed or prohibited controlled substances or illegal drugs in my urine. I further freely and voluntarily authorize the company-designated laboratory to release and discuss with Hollywood Markets all test results of the drug screening urine test. I understand that a documented chain of specimen custody will be made to ensure the identity and integrity of my urine sample throughout the collection and testing process. I understand that if I refuse to consent, or the test is confirmed positive, the offer of employment will be rescinded. Note: parent/legal guardian consent is required for drug/alcohol testing for minor children (see signature section below).

I understand, and agree that if hired, my employment and compensation can be terminated by me or the company with or without cause, and with or without notice, at any time within 90 workdays after my date of hire. After that time, I understand and agree that my employment is subject to termination anytime the company determines, in its sole discretion, that my performance is not satisfactory to the company. I understand that no manager or representative of Hollywood Markets, other than the president of the company, has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing. Any such agreement with the president of the company must be in writing and pertain specifically to me, or it shall be of no effect.

In exchange for the Company considering my Application for Employment, and except as prohibited by law, I agree that I must file any and all claims, charges, and/or lawsuits arising out of or pertaining in any way to my Application for Employment, employment, or termination of employment within 180 days of the event giving rise to the claim, charge, or lawsuit or shorter period as provided by law. I understand that applicable statutes of limitations may be longer than 180 days. However, I agree to be bound by this shorter, 180-day period of limitations and accordingly waive any statutes of limitations that may be longer. This waiver includes, but not limited to, waiver of statutes of limitations that apply to state or federal civil rights statutes.

All of the information on this application and made in conjunction with this application is correct and true to the best of my knowledge. I authorize Hollywood Markets to verify all information supplied on or in connection with this application. I understand that any false or misleading statement made by me in connection with this application or the failure to disclose any pertinent information will be grounds for non-hire or immediate dismissal.

I certify that the information contained in this application is correct to the best of my knowledge and understand that the deliberate falsification of this information is grounds for dismissal in accordance with this company’s policy. I authorize the references listed above to give you lawful information concerning my previous employment. I agree to undergo a character investigation and I agree to take a honest verification test in accordance with State and Federal laws upon reasonable suspicion of any and all discrepancies involving my work.

Applicant Signature

 

Date:

Parent/Legal Guardian Signature/Consent to Drug/Alcohol Testing of Minor Child

 

Date:

Associate Resources, LLC