Application for Employment

Please fill out the form below:

Today's Date

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 another Company that dealt with WIC?

Yes No

Are you Bilingual?

Yes No

If yes, what languages do you speak?

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

Hours available to work?

Days available to work?

Have you ever been convicted of a crime or felony

Yes No

If you answered yes, please explain why.

How did you hear about our Company?

Do you know anyone (Relative/Friend) that works with our Company?

Yes No

If yes, please put Name of Person and Location that they worked:

Is this person still employed with our company?

Yes No

Are you willing to travel?

Yes No

If so please check all the different stores:

Do you have proper transportation?

Yes No

Do you have proper Child Care available?

Yes No

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?