21 Country Market, Inc.

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21 Country Market, Inc.

Pre-Employment Application

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* Indicates required question

Name *

Your answer

Address *

Your answer

Phone Number *

Your answer

Email address *

Your answer

Are you currently employed? *

Yes

No

If yes, how long have you been at your current position? *

Your answer

If no, why? *

Your answer

How many hours do you want per week? *

Your answer

Do you shop with us? *

Yes

No

If yes, what do you like about the store? *

Your answer

What can we do better? *

Your answer

Why do you want to work here and how long do you see yourself staying if you enjoy the job? *

Your answer

Referred By *

Your answer

I verify that answers given herein are true and complete. *

Type name below:

Your answer

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