Today’s date

Job/Position you are applying for (must be filled in)Application for Employment
This application will remain active for 60 days. Applicants must renew their applications every 60 days to maintain “active” status and be considered for otherjob openings. There is no need to follow up about your application submission. We will contact you if we have a position open and your background,experience, and availability match the job requirements.

GENERAL INFORMATION:
Name

Email Address

Address

Phone numberCityStateZip CodeEMPLOYMENT RECORD: STARTING WITH PRESENT or MOST RECENT, list all previous employers. Include self-employment, military
service, summer, and part-time jobs. Please attach additional sheets if necessary, following the same format.
Dates
Employed

Name & Address of Current or Former Employer
Company Name

Phone

No. & Street
City & State

Zip

Company Name

Phone

No. & Street
City & State

Zip

Company Name

Phone

No. & Street
City & State

Zip

Company Name

Phone

No. & Street
City & StateZip

MISCELLANEOUS:
May we contact your current employer(s)?

Positions &Supervisors

FromMo./Yr.

Position (below)________________ToMo./Yr.

______________
Supervisor’s
Name (below)

FromMo./Yr.

Position________________
ToMo./Yr.

_____________
Supervisor’s
Name

FromMo./Yr.

Position________________To
Mo./Yr.

______________
Supervisor’s
Name

FromMo./Yr.

Position________________To
Mo./Yr.

______________
Supervisor’s
Name

 Yes

DutiesReason for Leaving

 No

Do you know anyone presently working for our company? _____ If so, who? _______________________________________________

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REFERENCES: (Not relatives)
Name

Occupation

Address

Telephone No.

NameOccupation

Address

Telephone No.

EDUCATION:Education

Name of School

No. of Yrs.
AttendedAddress

DegreesHigh School
CollegeOther(graduateschool, tradeschool, etc.)

PLEASE COMPLETE THE FOLLOWING QUESTIONS
1.

Why do you want to work for Down to Earth?

2.

How many times have you shopped at Down to Earth or other natural foods stores in the past month?

3.

What are your thoughts about vegetarian diets?

4.

Do you use any nicotine/tobacco-based products (including e-cigarettes or vaporizers)? _____ Yes _____ Noa.

If you smoke/vape, how often do you smoke/vape per day?
_____________________________________________________________

5.

What type of employment are you looking for? _____ FULL-TIME (35+ hours/week) _____ PART-TIME (less than 35 hours per week)a.

If part-time, how many days and/or hours per week would you like to work? ________________________________________

6.

If we invite you to join our team, how long do you intend to stay with us? __________________________________________________

7.

Please select the days and times you are available to work
(Approximate shift start times: Morning: Before 10 am, Evening: After 2 pm; Store Hours available online and posted in store)
SUNDAY

8.

MONDAYTUESDAYWEDNESDAY

THURSDAYFRIDAY

SATURDAYMORNINGMORNINGMORNINGMORNINGMORNINGMORNING

MORNINGEVENINGEVENINGEVENINGEVENINGEVENINGEVENINGEVENINGHow did you hear about the position? E.g. Internet (which website?), DTE Team Member, customer, other (please be specific):

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MEDICAL INFORMATION:
After an offer of employment is made, but before employment duties begin, applicant may be required to undergo a physical or medical examination at Company expense andby a Company-chosen physician, with the offer of employment conditioned on the result of such examination. Team Members, at any time during the course of their employment,
may be required to undergo a medical examination at Company expense and by a Company-chosen physician.
Are you able to perform the essential functions of this job with or without reasonable accommodation? ___________

Applicant initials _____________NOTE:
It is the policy of this Company to hire only U. S. citizens and aliens who are authorized to work in this country. (As a condition of employment, you will be required to produce
original documents establishing your identity and authorization to work, and to complete the U.S. Immigration and Naturalization Service’s Form I-9.)
Down to Earth is proud to provide a drug-free workplace. All job offers are made subject to passing a drug test.
All job offers are conditional upon a check for any criminal conviction in the recent ten (10) years (excluding any period of incarceration), that is rationally related to the duties
and responsibility of the job.

ACKNOWLEDGMENT AND CERTIFICATION:
By signing below, I certify that all statements made on this application are true and complete to the best of my knowledge. I understand thatmy application will not be considered if it is incomplete. Further, I understand that any misrepresentation or omission made herein, whendiscovered, may subject me to discharge. I authorize the Company to investigate my work history, education, character, reputation, andbackground as it deems necessary for purposes of considering my application for employment. In exchange for the Company’s considerationof my application for employment, I hereby release the Company and all providers of information (including, but not limited to, any of myformer employers, educational institutions attended, and personal references) from all liability relating to or arising out of any inquiry by theCompany regarding my work history, education, character, reputation, and background.
This application is not a contract of employment and cannot create a contract of employment for any specific period. I understandthat if I am employed, my employment is “at will” and can be terminated at any time, either by myself or the Company, with orwithout cause or reason and with or without notice.

_______________________________________________
Applicant Signature_____________________________
Application Date

Down to Earth is an Equal Employment Opportunity Employer

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