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 This Section is experimental. Should you choose to submit an application via this method, it is advised that you visit the store you are applying to in person.

 

Desired Position(s): 

Choose Store Applying For: 
          7519 Outer Loop
          5301 Mitscher Ave          205 Oakbrooke, Mt. Washington, Ky
          315 Whittington Pkwy     1250 Bardstown Road         

Date of Application:   

Attach Resume: 
 
How did you learn about our company?  Advertisement     Relative     Friend
Other: 
Last Name:       First:       Middle: 
Street Address: 
City:       State:       Zip Code: 
Home Phone:       Cell Phone: 
Type of position desired:  Full Time     Part Time     Temporary  
If you are under the age of 18, can you provide required proof of your eligibility to work?
Are you currently employed?
May we contact your present employer?
Are you prevented from lawfully becoming employed in this country because of visa or immigration status?  *Proof of citizenship or immigration status will be required upon employment.
On What date will you be available for work?  		Yes No
Yes No
Yes No
Yes No
Have you ever been convicted of a crime? 
*Conviction will not disqualify an applicant from employment.
If Yes Please Explain:
 Yes No
Education

Grade School:     Last Year Completed:    Graduate? 

Yes No
High School:        Last Year Completed:    Graduate? Yes No
College:               Last Year Completed:    Graduate? Yes No
Special Training:    Last Year Completed:   Graduate? Yes No
Are you Currently a student?  Yes No 
Do you have a degree?  Yes No              If Yes What degree? 
References

Family Member (not living in the same house)
Name:       Phone Number: 

Personal References
Name:       Phone Number: 
Name:       Phone Number: 

Work History

1.  Employer Name:       Address: 
Phone Number:       Job Title: 
Supervisor:       Reason for leaving: 
Dates Employed:  to      Rate When Leaving: 
Your Duties:

2.  Employer Name:       Address: 
Phone Number:       Job Title: 
Supervisor:       Reason for leaving: 
Dates Employed:  to      Rate When Leaving: 
Your Duties:

3.  Employer Name:       Address: 
Phone Number:       Job Title: 
Supervisor:       Reason for leaving: 
Dates Employed:  to      Rate When Leaving: 
Your Duties:

4.  Employer Name:       Address: 
Phone Number:       Job Title: 
Supervisor:       Reason for leaving: 
Dates Employed:  to      Rate When Leaving: 
Your Duties:
Briefly describe why you desire a position with this company and why you think you would make a valuable employment?
It is understood that, if my application is considered favorably, and any false or misleading statement on this application will be considered sufficient cause for dismissal.  I agree to undergo a post offer physical examination and character investigation at ValuMarket's expense: and realize that my employment is contingent upon my passing such examination and investigation according to standards established by ValuMarket.  Further, I hereby release my former employers from all liability for damages on account of having furnished information regarding my personal character, habits, work record, etc.

I agree with the above statement

Signature:       Date: