Employment Application - Cubby's Convenience Stores

Name

First Last

Email

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Employment Eligibility

Are you a U.S. citizen or authorized to work in the U.S. on an unrestricted basis?*

Yes
No

Have you ever been convicted of a misdemeanor or a felony, or do you currently have any criminal cases pending?*

Yes
No

If YES, please give the date, location, and disposition of your case.*

What store are you interested in?

What job are you interested in?

Customer Service Representative-CSR
Assistant Manager
Store Manager
Food Service Lead
Food Service Manager
Area Supervisor

Phil's Jobs

Grocery Clerks
Grocery Stockers

*I understand that applicants who do not meet the minimum qualifications of the position will not be considered for the position. Only those final candidates will be contacted.

Desired Pay

Per

Hour
Week

How many hours do you want to work per week?

10
20
30
40+

What times are you available to work?

Mornings. 7am-3pm
Evenings. 3pm-11pm
Nights. 11pm—7am
Weekends

Please mark the days you are NOT available to work.

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

When are you able to start?

Are you 16 years of age?

Yes
No

Are you 19 years of age?

Yes
No

Are you 21 years of age?

Yes
No

Positions require minimal lifting ability (approx. 40 lbs.). Do you have any injuries or physical conditions that will impair your ability to lift products?

Yes
No

Employment History

Job Title

Position

Company

Company Name

Dates

Start Date End Date

Duties

Address

Street Address Address Line 2 City State ZIP Code

Supervisor Name

Name Phone Number

Reason for Leaving

Past Employer 2

Job Title

Position

Company

Company Name

Dates

Start Date End Date

Duties

Address

Street Address Address Line 2 City State ZIP Code

Supervisor Name

Name Phone Number

Reason for Leaving

Consent*

Please type your initials and email address in the following boxes. By doing so and submitting this form to Cubby's you are agreeing to the terms and conditions stated above.

PLEASE READ CAREFULLY
I hereby certify that the answers to the foregoing questions are true to the best of my knowledge and agree to have any of the statements checked by Cubby's unless I have indicated to the contrary.
I am aware that a more detailed investigation concerning background and credit may also be conducted, if applicable to the job for which I am applying, and I hereby authorize such an investigation.

I understand that employment is contingent upon satisfactory completion of reference checks and that, upon my written request, information on the nature and scope of an inquiry, if one is made, will be provided to me.

I understand that nothing contained in this employment application is intended to lead to or create an employment contract between Cubby's or any subsidiary or affiliate and myself which would in any way restrict the right of the company to terminate my employment at will.

I further understand and agree that the employment relationship that may result from my application will be employment-at-will, and either I or Cubby's or any subsidiary or affiliate may terminate the relationship at any time.

I understand that any omission, misrepresentation or falsification can be grounds for refusal of employment. I further understand that, if employed, any false statements or misrepresentations herein or in conjunction with the application process may be cause for dismissal.

I understand that any and all disputes regarding my employment with Cubby's, including any disputes relating to the termination of my employment, are subject to the Cubby's Company Policy. I also understand and agree, as a condition of employment and continued employment, to submit any such disputes in accordance with Company Policy.

Name

This field is for validation purposes and should be left unchanged.