CITY OF LIVERMORE

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					                                                          An Equal Opportunity Employer
                                                                                                                                          HR DEPT. USE ONLY

                                                                                                                                    Reviewed by:
                                              Super Value Liquors, Inc.                                                             Comments:
                                                                SUBMIT YOUR APPLICATION TO:
                                                      Human Resources Department
                                             597 Centre Street, Brockton, Massachusetts 02302
                                                                508-587-2845
                                                HumanResources@SuperValueLiquors.com

                                                       EMPLOYMENT APPLICATION
 NAME:          Last                                              First                                                  Middle Initial


 ADDRESS:      Number              Street                       Apt. #                     City                            State                   Zip Code


 Home Phone:                            Cell Phone:                          Social Security Number:                             Email Address:
 (   )                                  (     )


 Please list any other names you have used while working.                       Please list the name and telephone number of a person to notify in case of an
                                                                                emergency.



 As a liquor store employee you must be at least 18 years of age at time of     Certain positions require you to be at least 21 years of age at time of hire.
 hire. Can you meet this requirement?                                           Can you meet this requirement?
                               Yes     No                                                                             Yes       No 


 Have you ever been discharged from employment or been forced to
 resign?                                                                        Have you ever been TIPS certified?           Yes          No 
                          Yes      No                                         If yes, is your certification current?       Yes          No 

 If yes, please explain providing details.     Attach a separate sheet, if
 necessary.                                                                     May we contact the employers listed on this application for the purposes of
                                                                                conducting a reference check of your employment?
                                                                                                Current employer?     Yes     No 
                                                                                                Previous employer? Yes        No 



 Do you have a current, unexpired, unrestricted driver’s license?         Yes        No   
 Do you speak, read or write languages other than English?                Yes        No    If yes please list:
 Do you have prior retail and/or liquor industry experience?              Yes        No   
 Do you have experience selling Massachusetts Lottery products?           Yes        No   



 CONVICTIONS:

 A “yes” will not necessarily disqualify an applicant from employment. Each case will be examined on the basis of job relatedness and recency.

  Have you ever been convicted of a crime other than a minor traffic violation? Yes  No 
  Have you been arrested for and charged with a crime for which you are currently out on bail or on your own recognizance pending trial? Yes            No 

 If you answered “yes” to either of the above questions, attach a separate sheet and provide the following: date, charge of offense, city and state, court, and
 action taken.



It is important that you answer all questions and thoroughly complete all pages of this application form. You may attach a resume if you wish, but not
completing information requested on the application may disqualify you from further consideration. All statements are subject to verification and any
information that is inaccurate or untruthful could result in loss of employment rights or a job.


CERTIFICATE OF APPLICANT: I hereby certify that all statements made in this application and all other submitted documents are completed and true. I
understand that any misstatements, omission of material facts, or failure to complete the application, supplemental questionnaire, and other documents will
subject me to disqualification or termination of employment, no matter when discovered. If offered employment, I can meet Federal and State citizenship
standards for employment and I consent to a criminal history, credit and motor vehicle records check to be obtained by the employer.

SIGNATURE:                                                                                               DATE:
                                      If you move, please notify the Human Resources Department of your new address.
(LAST NAME, FIRST NAME):                                                         POSITION APPLYING FOR:



EDUCATION: Name and Location of High School
Highest grade completed:    8   9   10     11     12   High School Graduate?     Yes      No 
If “No,” GED or High School Proficiency Certificate? Yes           No 

                                                                 Semester/        Degree/Certificate                                      Dates Attended
Name of College or University                   Location         Qtr. Units           Received                 Major Subjects             From -      To




Licenses or Certificates relating to this position. (Attach copies.)               Computer Literacy: List software that you are proficient in using.




EMPLOYMENT EXPERIENCE: Starting with your most recent experience, list all jobs for the last 10 years and explain any time periods in which you were
unemployed. List each position separately. If you have relevant experience and it is more than 10 years old, be sure to document this experience also. List
all paid, volunteer, part-time, and internship experience; it will be prorated to a full time equivalent. If additional space is needed, make a copy of this
Employment Experience Section or attach additional pages, as needed. A resume will not substitute for the information required in this section.


Dates of Employment                      Employer                       Type of Business          Job Title                                # Supervised
FR: Mo/Yr
TO: Mo/Yr
Hours Per Week:                          Street Address          City          State/Zip          Name, title, and phone number of supervisor

Monthly Salary:                          Duties

Reason for leaving:




Dates of Employment                      Employer                       Type of Business          Job Title                                # Supervised
FR: Mo/Yr
TO: Mo/Yr
Hours Per Week:                          Street Address          City          State/Zip          Name, title, and phone number of supervisor

Monthly Salary:                          Duties

Reason for leaving:




Dates of Employment                      Employer                       Type of Business          Job Title                                # Supervised
FR: Mo/Yr
TO: Mo/Yr
Hours Per Week:                          Street Address          City          State/Zip          Name, title, and phone number of supervisor

Monthly Salary:                          Duties

Reason for leaving:




Dates of Employment                      Employer                       Type of Business          Job Title                                # Supervised
FR: Mo/Yr
TO: Mo/Yr
Hours Per Week:                          Street Address          City          State/Zip          Name, title, and phone number of supervisor

Monthly Salary:                          Duties

Reason for leaving:

				
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posted:9/29/2012
language:Spanish
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