Crossroads Pantry
Employment Application

Which location(s) are you applying for? *

Select all that apply.

Markle, IN

Geneva, IN

Warren, IN

Which position(s) are you applying for? *

Select all that apply.

Team Member - Cashier

Team Member - Cook

Team Member - Stocker

Desired Employment *

Select all that apply.

Part-Time

Full-Time

Your Availability *

Select all that apply.

First Shift

Second Shift

Third Shift

Weekdays

Weekends

Name *

First Name

Last Name

Phone *

(###)

###

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Referred By

If you were referred by a current Crossroads Pantry employee, please indicate their name.

First Name

Last Name

Are you a United States Citizen? *

Yes

No

If not a citizen, are you authorized to work in the United States?

Yes

No

Have you ever worked for Crossroads Pantry? *

Yes

No

Did you graduate?

Yes

No

Did you graduate?

Yes

No

Name *

First Name

Last Name

Reference's Phone Number *

(###)

###

####

Name *

First Name

Last Name

Reference's Phone Number *

(###)

###

####

Name

First Name

Last Name

Reference's Phone Number

(###)

###

####

Supervisor Name

First Name

Last Name

Supervisor Phone Number

(###)

###

####

May we contact this supervisor for a reference?

Yes

No

Supervisor Name

First Name

Last Name

Supervisor Phone Number

(###)

###

####

May we contact this supervisor for a reference?

Yes

No

Supervisor Name

First Name

Last Name

Supervisor Phone Number

(###)

###

####

May we contact this supervisor for a reference?

Yes

No

Disclaimer *

Please carefully read the statement below before agreeing and submitting your application.

By submitting this application, I consent to Crossroads Pantry contacting me about my application using the contact information I have provided. I certify that the answers I have provided on this application are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I understand that incomplete applications will not be reviewed for employment. I understand that, by submitting this application, I am not guaranteed an interview or employment.

Today's Date *

MM

DD

YYYY