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Employment

Employment Application

* Required Field

Applicant Information

Name(Required)

First Last

Email(Required)

Phone(Required)

Current Street Address(Required)

Current City(Required)

Current State and Zip Code(Required)

State ZIP Code

Mailing Address same as Current Address(Required)

Yes

No

Mailing Street Address(Required)

Mailing City(Required)

Mailing State and Zip Code(Required)

State ZIP Code

May we perform a background check on you?(Required)

Yes

No

Provide any different names you have utilized since age 18, if any:

Position(s) Applying For(Required)

(be specific – max 3)

The essential function of most jobs here will require that employees lift up to 50 lbs. frequently, bend and stoop frequently, push carts frequently, stand and/or walk for long periods of time, some climbing, and work in extreme temperatures. To the extent these function may be applicable to the position for which you are applying, can you perform all of the above functions with reasonable accomodation?(Required)

Yes

No

Answering “NO” to this inquiry is not an automatic bar to employment. We are an equal opportunity employer and complies with all facets of the American with Disabilities Act (and any applicable state laws).

What shift are you available to work:(Required)

Weekday Mornings

Weekday Afternoons

Weekday Evenings

Weekend Mornings

Weekend Afternoons

Weekend Evenings

Other

Select all that apply.

Explain Other Availability:(Required)

Any availability restrictions/exclusions?

Date Available(Required)

MM slash DD slash YYYY

Are you looking for Full-Time or Part-Time work?(Required)

Full-Time

Part-Time

Desired Salary(Required)

Are You At Least 18 Years Of Age?(Required)

Yes

No

What is your age?(Required)

Please enter a number from 14 to 17.

Please enter your age if you are under 18.

Are You Legally Eligible To Work In The United States?(Required)

Yes

No

Do You Have a Reliable Source of Transportation To And From Work?(Required)

Yes

No

Have you served in the military?(Required)

Yes

No

Where you honorably discharged?(Required)

Yes

No

Branch:(Required)

Years:(Required)

Rank At Discharge:(Required)

Education

High School Diploma or GED?(Required)

Yes

No

Highest Grade of Year Completed In School(Required)

High School Name:(Required)

Location:(Required)

Training Beyond High School (College, University or Other Schools)(Required)

Yes

No

School Name:(Required)

Location:(Required)

Major Field:(Required)

Years Attended:(Required)

Credits Earned:

GPA/Basis:

Degree Earned:(Required)

Describe any other education or training which you feel is relevant to the jobs(s) for which are you are applying. Also include relevant licenses and certifications. Be Specific.

Work Experience

Provide a description of all jobs. Be specific. Start with you most recent job. For part-time work, show the average number of hours worked per week. Indicate any change in job title with the same employer as a separate job.

Number of Previous Jobs(Required)

None

One

Two

Three

Previous Job 1

Employer:

Type of Business:

Street:

City:

State and Zip Code

State ZIP Code

Job Title:

Reason For Leaving:

Employment Status

Name of Supervisor:

Job Duties:

From (Month & Year):

To (Month & Year):

Previous Job 2

Employer:

Type of Business:

Street:

City:

State and Zip Code

State ZIP Code

Job Title:

Reason For Leaving:

Employment Status

Name of Supervisor:

Job Duties:

From (Month & Year):

To (Month & Year):

Previous Job 3

Employer:

Type of Business:

Street:

City:

State and Zip Code

State ZIP Code

Job Title:

Reason For Leaving:

Employment Status

Name of Supervisor:

Job Duties:

From (Month & Year):

To (Month & Year):

May we communicate with your present employer?(Required)

Yes

No

May we communicate with your former employer?(Required)

Yes

No

Have you done any volunteer work?(Required)

Yes

No

Please describe your volunteer work:(Required)

Have you worked for this company before?(Required)

Yes

No

What position?(Required)

What years?(Required)

References

List up to three references other than former employers or relatives.

Name:

Address:

Phone:

Name:

Address:

Phone:

Name:

Address:

Phone:

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Applicant Signature(Required)

(Type Name)

Date(Required)

MM slash DD slash YYYY

CAPTCHA

Our Address

Juba's Supervalu
219 South Main Street
Blue Earth, Minnesota 56013

Our Phone Number

(507) 526-2161

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Our Store Hours

Monday - Sunday: 7:00am - 9:00pm

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