Careers

Employment Application

Programs, services and employment are equally available to everyone. Please inform the Human Resources Department if you require reasonable accommodation for the application or interview

How were you referred to us

Position Applied for

Full Name

Address

City

State

Zip

Phone

Mobile/Pager/Other

Email

Date Available to Start

If you are 18 years of age, can you provide a work permit?

YesNo

Have you ever worked for this company?

YesNo

Are you legally allowed to work in the United States?

YesNo

Answering no to these questions does not constitute an automatic rejection for employment

Types of employment desired

Full-TimePart-TimeTemporarySeasonal

Driver's license number

State

Education History

Name & Location of High School

Did you graduate?

Name & Location of College

Years Attended

Degrees completed

Other Subjects Studied

Traded, Business or Correspondence School

Years attended

Subjects Studied

Did you graduate

Summarize Your Special Skill or Qualifications

Previous Employment (begin with the most recent position)

Company Name

Address

City

State

Zip

Phone

Supervisor

Title

Responsibilities

Starting Salary

Ending Salary

Reason for Leaving

May we contact this employer for a reference?

YesNo

Dates of Employment

Position(s) Held

Company Name

Address

City

State

Zip

Phone

Supervisor

Title

Responsibilities

Starting Salary

Ending Salary

Reason for Leaving

May we contact this employer for a reference?

YesNo

Dates of Employment

Position(s) Held

Company Name

Address

City

State

Zip

Phone

Supervisor

Title

Responsibilities

Starting Salary

Ending Salary

Reason for Leaving

May we contact this employer for a reference?

YesNo

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employees listed above to give you and and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."

Signature of Applicant

Date

This application for employment is sold only for general use throughout the United States. TOPS assumes no responsibility and hereby disclaims any liability for the inclusion in this form of any questions or requests for information upon which a violation of local, state, and/or federal law may be based. It is the user's responsibility to ensure that this form's use complies with applicable laws, which change from time to time.