First  name:__________________________Last name:__________________________

Current address:______________________City,State,Zip:_______________________

HomePhone:_________________________Other Phone: _________________________

Best Phone to Reach Me: ________________

Expected wage Earnings: ________________

Email: _______________________________

Date available for Employment____________

Positions you are interested in:

ÿ Cashier/Bagger ÿ Produce ÿ Meat Service ÿ Grocery ÿ Customer Service

ÿ Bookkeeping ÿ Stocking/Food Prep

ÿ Full time ÿ Part time

Maximum number of hours you would want to work: _________________

Minimum number of hours you would want to work: _________________

Our People

We recruit the best people we can to become apart of our team. We create as atmosphere that encourages decision making on ones own, creating a respectful workplace where people are treated fairly and are highly motivated to succeed. We look for people who are passionate about food. Our team members are also well-rounded human beings. They will play a critical role in helping build the store into a profitable and beneficial part of the community.

Hours that you can not work: _______________________________________________________________

Hours you are available to work:

Are you 18years of age or older? ________________________

Have you applied for employment with ILOM before? __________

How did you hear about this Position? ______________________

Do you have any knowledge of Organics? ___________________

Thought-Provoking Questions:

Why would you like to work at Iowa Lakes Organic Market?

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Give us an example of what exceptional customer service means to you.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

In your previous jobs and other experiences, what have been your most significant and meaningful accomplishments that relate to the job for which you are applying?

 ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Can you perform the requirements of the job with or without reasonable accommodation?__________

If hired, can you provide proof that you are eligible to work in the U.S.? ____________________

Has an employer ever discharged you? If yes, please explain all terminations.

_________________________________________________________________________________

List all periods of unemployment and how you spent this time:

 _________________________________________________________

_____________________________________________________________________________

Have you been convicted of a felony and/or served time in the past seven years? If yes, list date, city, charge and disposition (in accordance with company policy this information will be reviewed for job relatedness and time since last conviction)______________________________

_________________________________________________________________

Do you have other commitments to another employer, or school that might affect your employment at ILOM?__________________________________________________________

What?__________________________________________________________

Do you have skills or experience in the following areas?

ÿ Cashiering ÿ Retail Merchandising ÿ Produce ÿ Natural/Organic Foods

ÿ Customer service ÿ Restaurants ÿ Other_________________________________________

Certification and Release

I certify that I have read and understand the application and that the answers given by me to the foregoing questions and statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omission or misrepresentation of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I authorized the company and /or its agents to verify any of this information. I authorize all persons, schools, companies, and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I agree that if I am employed, my employment shall not be construed as being for any definite period of time but will be for an indefinite period, terminable at will by the company or me.

SIGNED_______________________________________________DATE__________________

Your application may not be considered unless every question is answered. Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are critical. List in order, starting with the most recent or current employer.

Company Name_________________________________ May we contact? ___________