Name
*
First Name
Last Name
Please Select What Store You Are Applying To
Please Select
Grand Rapids C-Store
Deer River C-Store
Remer C-Store
Long Prairie C Store
Deer River Marketplace
Phone Number
*
Format: (000) 000-0000.
Social Security Number
000-00-0000
Date
-
Month
-
Day
Year
Date
Drivers License Number And State
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If not a resident at current address for 2 years give previous address and phone number
Lived there from:
To
Are you a United States Citizen or legally authorized to work
Please Select
Yes
No
List residence for past 7 years
Do you have relatives that work for this company? If yes give name and department
Have you worked for this company before?
In case of a emergency who should we notify?
Please fill out the emergency contact information below
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Position applying for
Referred by
Type of employment desired
Full Time
Part Time
Summer
Temporary
Shift Preference
Salary Required
Are you willing to work overtime?
Yes
No
Are you willing to work weekends?
Yes
No
Date available to begin work
-
Month
-
Day
Year
Date
Are you over 18?
Yes
No
Are you 21 or over?
Yes
No
Please include the name and address of school attended
High School Start
-
Month
-
Day
Year
Date
High School End
-
Month
-
Day
Year
Date
College Start
-
Month
-
Day
Year
Date
College End
-
Month
-
Day
Year
Date
Other Start
-
Month
-
Day
Year
Date
Other End
-
Month
-
Day
Year
Date
Reference #1
Reference #2
Reference #3
Special Skills or Qualifications
Job History
Special Skills or Qualifications
Job Start
-
Month
-
Day
Year
Date
Job End
-
Month
-
Day
Year
Date
Were You Fired?
Yes
No
Job Start
-
Month
-
Day
Year
Date
Job End
-
Month
-
Day
Year
Date
Were You Fired?
Yes
No
Job Start
-
Month
-
Day
Year
Date
Job End
-
Month
-
Day
Year
Date
Were You Fired?
Yes
No
TO BE READ AND SIGNED BY APPLICANT
I certify that the foregoing statements are true and correct. I authorize the Northern Star Cooperative Services to make investigation of my personal or employment history and authorize any present/former employer, person, firm, corporation, credit agency or government agency to give the Northern Star Cooperative Services any information they may have regarding me, and I understand that any misrepresentation or omission shall be cause for dismissal. In consideration of the prospective employer review of this application, I release the Northern Star Cooperative Services and all providers of information from any liability as a result of furnishing and receiving this information. I further agree that, if employed, I will conform my conduct to the Northern Star Cooperative Services rules, regulations, and personnel policies. I understand that no personnel recruiter, interviewer or other representative other than an officer of the Northern Star Cooperative Services has authority to enter into any agreement for employment for any specified period of time and that any employment manuals or handbooks that may be distributed to me during the course of my employment shall not be construed as a contract. I further understand that nothing contained in this application, or the granting of an interview creates a contract for either employment or providing any benefit, and THAT I HAVE THE RIGHT TO TERMINATE EMPLOYMENT AT ANY TIME AND THAT THE COMPANY HAS THE SAME RIGHT.
Signature
Submit Application
Should be Empty: