Gerrity's Supermarket

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Gerrity's Online Application

PERSONAL INFORMATION

First, M.I., Last Name:
Address:
City, State, Zip:
Phone Number:
Social Security Number:
I am 18 or over:	yes no

Are you prevented from lawfully becoming employed in this country 
because of Visa or immigrant status?  
yes  no

EMPLOYMENT DESIRED

Position:
Date you can Start:
Salary Desired:
Are you employed Now?
If yes, can we inquire of your present employer?
Have you ever applied to this company before?
If yes, where? when?
Referred by:

EDUCATION

Grammar

School Name:
Address:
City, State, Zip:
Number of years attended:
Did you graduate?
Subjects Studied:

High School

School Name:
Address:
City, State, Zip:
Number of years attended:
Did you graduate?
Subjects Studied:

College/University

School Name:
Address:
City, State, Zip:
Number of years attended:
Did you graduate?
Subjects Studied:

Trade/Business or Correspondence

School Name:
Address:
City, State, Zip:
Number of years attended:
Did you graduate?
Subjects Studied:

GENERAL

Subjects of special study or research work:
 
   
Special Skills:
 
       
Activities: (Civic, Athletic, etc.)
 *exclude organizations, the name of which indicates the race, creed, sex, 
age, marital status, color or nation of origin of its members

U.S. Military or Naval Service:
Rank:
Present membership in:
National Guard or Reserves:

FORMER EMPLOYERS
List below last three employers, starting with the most recent one first.

Employer 1

Employer Name:
Address:
City, State, Zip:
Date Started:
Date Resigned:
Salary:
Position:
Reason for Leaving:

Employer 2

Employer Name:
Address:
City, State, Zip:
Date Started:
Date Resigned:
Salary:
Position:
Reason for Leaving:

Employer 3

Employer Name:
Address:
City, State, Zip:
Date Started:
Date Resigned:
Salary:
Position:
Reason for Leaving:

Which of these jobs did you like best?
What did you like most about this job?

REFERENCES
Give the names of three persons not related to you, whom you have known for at 
least one year.

Reference 1

Name:
Address:
City, State, Zip:
Business:
Years Aquainted:

Reference 2

Name:
Address:
City, State, Zip:
Business:
Years Aquainted:

Reference 3

Name:
Address:
City, State, Zip:
Business:
Years Aquainted: