JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Application for Employment
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name in Full (First, Middle Initial, Last Name)
*
Your answer
Address (Street, City, State, Zip Code)
*
Your answer
Phone number including Area Code
*
Your answer
Email
*
Your answer
Are you legal age to work?
*
YES
NO
Are you legally eligible for employment in the United States?
*
YES
NO
Have you ever been employed with B&R Stores?
*
(including Russ's Market, Super Saver, Apple Market, Allen's, Cash Saver and C&R)
YES
NO
IF YES, When? & Where?
Your answer
Do you have a relative or friend who is a current or previous employee of B&R Stores?
*
YES
NO
IF YES, Name? When? & Where?
Your answer
Have you been convicted of a crime in the last 7 years?
*
(excluding parking and speeding tickets)
YES
NO
IF YES, please explain, including month/year of conviction(s)
(A conviction will not necessarily bar you from employment, but will be considered in relaxation to specific job requirements)
Your answer
Position Applied for:
*
Your answer
What Store Location:
*
Choose
SHELBINA
MACON
EDINA
KAHOKA
MONROE CITY
CALIFORNIA
FAYETTE
BOONVILLE
FULTON
SLATER
What are your salary requirements?
*
Your answer
What is your availability?
*
FULL TIME
PART-TIME
SEASONAL
OTHER
Specific Days you're unable to work
Your answer
When are you available to start work?
*
MM
/
DD
/
YYYY
Are you currently employed?
*
YES
NO
Required
Please list any changes in availability you anticipate during the next 6 months:
Your answer
List any experiences, skills, or qualifications which will be of special benefit in the position for which you are applying:
Your answer
Please indicate what encouraged you to apply for a position with B&R Stores (select one):
Choose
B&R Website
Internet
Social Media
Store Sign
Friend or Relative
Walked In
Other
Education Background
High School
*
Your answer
Last Grade Completed
Your answer
Diploma or GED Earned:
Choose
YES
NO
College/Educational Institute
Your answer
Years Completed
Your answer
Major/Course of Study
Your answer
Degree or Certificate Earned:
Choose
YES
NO
Was any employment under a different name?
Choose
YES
NO
IF YES, please list:
Your answer
Employer:
List your MOST RECENT employment first:
Your answer
Phone:
Your answer
Address:
Your answer
Position Held
Your answer
Supervisor
Your answer
Job Duties
Your answer
Rate of Pay $
Your answer
Dates of Employment
Your answer
Reason for Leaving
Your answer
Employer:
List your MOST RECENT employment first:
Your answer
Phone:
Your answer
Address:
Your answer
Position Held
Your answer
Supervisor
Your answer
Job Duties
Your answer
Rate of Pay $
Your answer
Dates of Employment
Your answer
Reason for Leaving
Your answer
Employer:
List your MOST RECENT employment first:
Your answer
Phone:
Your answer
Address:
Your answer
Position Held
Your answer
Supervisor
Your answer
Job Duties
Your answer
Dates of Employment
Your answer
Rate of Pay $
Your answer
Reason for Leaving
Your answer
I certify that the information in this application is correct to the best of my knowledge and understand that should I become employed by B&R Stores, Inc. deliberate falsification of this information is grounds for dismissal.
*
Acknowledge
Required
You are hereby authorized to make any investigation of my personal history, employment record or any other area of pertinent information, and I release all parties from liability from damage. Any copy of this initialed authorization shall have the full force of the original.
*
Acknowledge
Required
Applicant Initials
*
Your answer
Date
*
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
