Application for Employment

Please fill out the form below:

Which Siempre Store Location are you applying for?

Full Name

Email Address

Phone Number

Mailing Address

Education Level

Have you ever been in the WIC program before?

Yes No

Have you ever worked for someone that receives WIC vouchers?

Yes No

Are you bilingual?

Yes No

Are you interested in Part-Time or Full-Time?

Part-Time Full-Time

Hours available to work?

Days available to work?

Are you willing to travel?

Yes No

Driver License # and State Issued:

Do you have proper transportation?

Yes No

Do you have proper Child Care available?

Yes No

Have you ever been convicted of a crime or felony

Yes No

If you answered yes, please explain why.

Job History One

Previous Employer One:

Telephone Number:

Reason for leaving?

May we contact them?

Yes No

Years there?

Hourly Pay?

Job History Two (Optional)

Previous Employer One:

Telephone Number:

Reason for leaving?

May we contact them?

Yes No

Years there?

Hourly Pay?

Job History Three (Optional)

Previous Employer One:

Telephone Number:

Reason for leaving?

May we contact them?

Yes No

Years there?

Hourly Pay?