Employment Application

VERMONT’S LONGEST RUNNING STORE. IN THE HEART OF JERICHO CENTER SINCE 1807!

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*Jericho Country Store is open 7 days/week and minor holidays. ALL EMPLOYEES are required to be available on weekends & minor holidays. DO NOT apply if unable to work at these times unless noted otherwise.

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Applicant Information

Full Name:

Date:

Address

Street Address:

Apartment/Unit #:

City:

State:

Zipcode:

Phone:

Email:

Date Available:

Desired Salary:

Position Applied for:

Are you a citizen of the United States?

Yes No

If no, are you authorized to work in the U.S.?

Yes No

Have you ever worked for this company?

Yes No

If yes, when?

Have you ever been convicted of a felony?

Yes No

If yes, explain:

Available weekends and holidays?

(applicants will NOT be considered if unavailable during weekends and minor holidays.)

Education

High School:

Address:

From:

To:

Did you graduate?

Yes No

Diploma:

College:

Address:

From:

To:

Degree:

References

Full Name:

Relationship:

Company:

Phone:

Address:

seperator

Full Name:

Relationship:

Company:

Phone:

Address:

seperator

Full Name:

Relationship:

Company:

Phone:

Address:

Previous Employment

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes No

seperator

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes No

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.

Signature:

Date:

Fields with (*) are compulsory.

MONDAY – FRIDAY 7am – 8pm
SATURDAY 8am – 8pm
SUNDAY 8am -7pm

(802) 899-3313
info@jerichocountrystore.com

25 Jericho Center Circle
PO Box 1039
Jericho Center, VT 05465

Website by Breezy Hill Marketing

Home
ABOUT US
Gallery
CONTACT US/WORK WITH US!
Order Online