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On-Line Application For Employment


We Welcome You To Apply
For A Position With Our
Marshalltown Store On-Line.

We Will Contact You For An Interview.
All Information Is Strictly Confidential.



Fill out the form below.
Use the TAB key to move from box to box.
Press SEND APPLICATION when your form is complete.



PERSONAL INFORMATION
First Name Middle Initial
Last Name
Street Address EMail Address
City State & Zip
Phone Number Social Security Number


Were you were referred by a current or past HyVee Employee Yes   No
If yes, please give their name


TYPE OF EMPLOYMENT DESIRED
Date available for employment (mm/dd/yr)
Full Time Regular Time Part Time Summer / Holiday


HOURS OF AVAILABILITY
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
From
To


ARE YOU AVAILABLE TO WORK?
Nights Weekends Overtime Holidays

WHERE WOULD YOU PREFER TO WORK?
Check all that may apply
Grocery Checker / Carry-Out Deli / Kitchen Meat Department Frozen Foods
Produce Department Bakery Seafood Department Dairy Department
Non-Foods Department Camera Department Cheese Island Floral Department
Italian Express Chinese Express Customer Service HealthMarket Department
Night Stock Crew Wine & Spirits HyVee Gas



EDUCATION
High School Years Completed Diploma Yes   No
College Years Completed Diploma Yes   No
Other School Years Completed Diploma Yes   No


PREVIOUS EMPLOYMENT
(list most recent employment first)

Company Name Supervisor Name
City and State Phone
Position
From (mm/dd/yr) To (mm/dd/yr.)
Reason For Leaving Pay Rate


Company Name Supervisor Name
City and State Phone
Position
From (mm/dd/yr) To (mm/dd/yr.)
Reason For Leaving Pay Rate


Company Name Supervisor Name
City and State Phone
Position
From (mm/dd/yr) To (mm/dd/yr.)
Reason For Leaving Pay Rate


May we contact your present employer? Yes   No
May we contact your previous employer(s)? Yes   No
Have you ever been convicted of a crime
Other than a traffic violation?		 Yes   No


By entering and sending this application for employment, I represent that the statements given by me in response to the information requested are true, correct and complete. Any false or misleading information given on this application or during the interview process shall be sufficient grounds for my discharge.

Hy-Vee Inc. cares about the health and safety of our employees and customers. We do not condone the illegal possession, distribution, sale or use of alcohol or drugs in the workplace. We consider this cause for immediate termination. Employment with Hy-Vee Inc. may be subject to successful completion of a company physical examination including a drug screen where applicable.

I further understand that, if employed by Hy-Vee Inc., unless provided otherwise by written agreement, my employment will be "at will" meaning that my employment can be termminated by Hy-Vee Inc. or me at any time, for any reason.

I authorize the company and/or it's agents to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I release all persons, schools, companies, and law enforcement authorities from any liability for any damages whatsoever for issuing this information.

I further understand that I will be required to sign a copy of this application during my interview, should I receive one.

Hy-Vee Inc. is proud to be an Equal Opportunity Employer.







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Email us: Marshalltown HyVee



Marshalltown HyVee Food Store
802 S. Center
Marshalltown, IA  50158
(641) 752-4525