All of us at Country Grocer are working hard to improve and grow our opportunities - for both the individual and the business. We are positive and active members of the communities that we are in. Whether you are applying for a part-time position as you go to school or whether you want to make or continue your career in the food business, we want individuals joining the Country Grocer team with positive, caring attitudes who enjoy working amidst lots of people and facing the day-to-day challenges of the fast paced retail food business.

*-Required information

Personal Information:

Last Name: *

Initial:

First Name: *

Home Phone: 

Business Phone:

Other Phone:

Present Address:

Street Address: *

Apt./Unit

City: *

Province: *

Postal Code: *

Previous Address:

Street Address: 

Apt./Unit

City: 

Province:

Postal Code:

Home Phone: 

Business Phone:

Other Phone:

Are you  eligible to be bonded? * YesNo

Are you legally entitled to work in Canada? * YesNo

Are you at least 15 years old? * YesNo

Have you been convicted of a felony in the last seven (7) years? * YesNo

If yes, please provide details of convictions that are a matter of public record (arrests are not convictions). 

A conviction will not necessarily disqualify you from employment with us.

Employment Desired (Please keep in mind that the availability of hours may vary).  Areas of interest.

Which of the following departments in the store would you be interested in working? *

Front EndProduce DeliBakery GroceryPostal Floral Meat Bulk Foods Office

Other:

Employment Status: *

Full Time Part Time Student

Wage/Salary Expected: *

Availability:

To meet the needs of our customers we are open extended hours seven days a week.

Please specify hours that you would be available for each day of the week.

From

To

Monday

12345 6789101112 a.m.p.m.

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Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Employment History (Most Recent First)

Present/Last Employer: *

Employed From: * Day 12345678910 111213 14151718192021222324252627 28293031 Month  JanuaryFebruaryMarchAprilMayJuneJuly AugustSeptemberOctoberNovemberDecember Year  2008 2007 2006 2005 2004 2003 2002 200120001999199819971996199519941993 199219911990 Prior

Employed To: *     Day 1234567891011 1213141517181920 2122232425262728 293031 Month  JanuaryFebruaryMarchAprilMayJuneJuly AugustSeptemberOctoberNovemberDecember Year  2008 2007 2006 2005 2004 2003 2002 200120001999199819971996 199519941993199219911990 Prior

Street Address: *

City: *

Supervisor's Name: *

Phone Number: *

Reason For Leaving: *

Position: *

Salary: *

Previous Employer:

Employed From: Day 12345678910 111213 1415171819202122232425262728293031 Month  JanuaryFebruaryMarchAprilMayJuneJuly AugustSeptemberOctoberNovemberDecember Year  2008 2007 2006 2005 2004 2003 2002 2001 200019991998199719961995199419931992 19911990 Prior

Employed To:     Day 12345678910111213 1415171819202122232425262728293031 Month  JanuaryFebruaryMarchAprilMayJuneJuly AugustSeptemberOctoberNovemberDecember Year  2008 2007 2006 2005 2004 2003 2002 2001 20001999199819971996199519941993 199219911990 Prior

Street Address:

City:

Supervisor's Name:

Phone Number:

Reason For Leaving:

Position:

Salary:

References (All references will be checked BEFORE an offer of employment is made)

List the names of two professional references whom you have known for at least one year. 

Name: *

Address: *

Phone Number: *

Business: *

Relationship: *

Name: *

Address: *

Phone Number: *

Business: *

Relationship: *

Education *

Years Completed

Diploma/Certificate Received

High School

YesNo

College

YesNo

University

YesNo

Trade or Technical School

YesNo

Other:

Additional Information

Have you ever been employed at Country Grocer or Food Country before? * YesNo

If yes, date left:     Day  1234567891011 121314 15171819202122232425 262728 293031 Month  JanuaryFebruaryMarchAprilMayJuneJuly AugustSeptemberOctoberNovemberDecember Year  2008 2007 2006 2005 2004 2003 2002 2001 20001999199819971996199519941993 1992 19911990 Prior

Department:  Manager 

Which location are you applying for? *   

Do you have any friends or relatives working for Country Grocer? * YesNo

If yes, list them:   

List any volunteer experience:  

List your hobbies: 

Do you have Food Safe Training? * YesNo     If Yes, what level? 

If Yes, indicate date training taken:  

 Day  1234567891011 121314 15171819202122232425 262728 293031 Month  JanuaryFebruaryMarchAprilMayJuneJuly AugustSeptemberOctoberNovemberDecember Year 2008 2007 2006 2005 2004 2003 2002 2001 20001999199819971996199519941993 1992 19911990 Prior

Do you have First Aid Training? * YesNo        If Yes, what level? 

If Yes, indicate date certificate expires:   

 Day  1234567891011 121314 15171819202122232425 262728 293031 Month  JanuaryFebruaryMarchAprilMayJuneJuly AugustSeptemberOctoberNovemberDecember Year  2008 2007 2006 2005 2004 2003 2002

Is your ability to perform the duties of the position that you are applying for likely to be affected by a previous illness or disability? *

 YesNo   If yes, please explain in the additional comments area below.

What influenced you to apply to Country Grocer? *

Additional comments (please include any other comments/clarification that you feel are necessary):

APPLICANT'S ACKNOWLEDGEMENT AND AGREEMENT

1. I hereby authorize Country Grocer to thoroughly investigate my background, references, employment record and other matters related to my suitability for employment.

2. I hereby authorize my current employer (if applicable) and all previous employers and organizations contacted by Country Grocer to provide any relevant information regarding my current and/or previous employment and I release all persons and employers of any and all claims for providing such information.

3. I acknowledge that my employment with Country Grocer may be with any one of Country Grocer's affiliated companies.  I also acknowledge and agree that I may be transferred between stores from time to time without change in the terms of my employment.

4. I acknowledge and agree that I will follow all of Country Grocer's policies and that failure to do so may result in administrative or disciplinary action and/or my employment being terminated.

5. I understand that I may be required to sign a confidentiality agreement should I become an employee of Country Grocer.

6. I understand that upon being offered a position, a bonding check may be conducted.

7. I certify that the information given by me in this application is true and complete, to the best of my knowledge.  I understand and agree that if I am employed, if any such statement on this application is at any time found to be false, such information may be cause for immediate dismissal.

TO THE APPLICANT

Country Grocer is an equal opportunity employer dedicated to a policy of non-discrimination in employment on any basis including race, ancestry, place of origin, political belief, religion, marital status, physical or mental disability, gender, age, or any other basis prohibited by federal or provincial law.

We appreciate your interest in our organization and assure that we are sincerely interested in your qualifications.  Our goal is to employ people who are interested in working in a team environment, who want to keep learning and growing as individuals and who truly enjoy being around lots of other people.

Thank you for your time.

Please enter today's date: *  Day  1234567891011 121314 15 16 171819202122232425 262728 293031 Month  JanuaryFebruaryMarchAprilMayJuneJuly AugustSeptemberOctoberNovemberDecember Year  2002200320042005200620072008