Vallarta Market Job Application Form – Fill Out and Use This PDF

APPLICATION FOR EMPLOYMENT

Vallarta Supermarkets offers many opportunities within our Company. Which Department(s) would you enjoy working in?

STORE OPPORTUNITIES:

Bakery Cashier Courtesy Clerks Customer Service Booth Deli/Dairy/Frozen Meat/Cremería Produce Taqueria Tortilleria Grocery Receiving Scan Janitorial

Option #1 Position Applying For: _____________________________ Option #2 Position Applying For: _____________________________

List skills relevant to the position(s) you are applying for: ______________________________________________________________________________

________________________________________________________________________________________________________________________

Reason for leaving Vallarta Supermarkets? _________________________________________________________________________________________

Are you able to perform the essential functions of the job for which you are applying, either with or without a reasonable accommodation? Yes No If “no, describe the functions that cannot be performed. __________________________________________________________________________________

(Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.)

WORKING SAFELY IS A CONDITION OF EMPLOYMENT

Vallarta Supermarkets is committed to providing a safe, healthy and secure work environment for our team members and customers through

our Work Safe programs. We achieve our Work Safe goals through partnership with our team members, managers and leadership. Vallarta Supermarket’s Work Safe programs are based upon the following principles:

Work Injuries and illnesses are preventable and we have a clear goal to achieve zero injuries.

Safety is everyone’s responsibility

Working safely is a condition of employment

Compliance with all applicable health and safety requirements is paramount.

The integrity of our Work Safe programs is ensured through sensible hiring, and comprehensive ongoing safety training that begins on every team member’s first day. At Vallarta Supermarkets, our work is never too urgent or too important so that we cannot take the time

to do it safely.

Vallarta is an equal opportunity employer. Vallarta provides equal employment opportunity for all applicants and prohibits discrimination based on race, color, sex (including pregnancy, childbirth, breastfeeding and medical conditions related to pregnancy, childbirth, or breastfeeding), gender, religious creed (including religious dress and grooming practices), marital status, domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic information and characteristics, sexual orientation, gender identity or expression, military or veteran status, or any other basis protected under federal, state, or local laws.

Vallarta will make reasonable accommodations, where appropriate, to assist applicants with disabilities with Vallarta’s application and hiring processes, if the accommodation does not result in an undue hardship to the Company or a direct threat to health and safety.

WORK EXPERIENCE

APPLICANT’S STATEMENT

PLEASE READ CAREFULLY BEFORE SIGNING!

I hereby certify the information on this application is correct and complete to the best of my knowledge.

I understand that falsification or omission of any material information on this application shall be grounds for rejection of this application or for immediate termination. I authorize the references listed to provide the Company any and all information concerning my previous employment and any pertinent information that they may have. Further, I release all parties and persons from any and all liability for any use or disclosure of such information by the Company or any of its agents, employees, or representatives. I agree that if employed, I will abide by all policies and procedures established by the employer. I agree to submit to Drug Testing if required, by Vallarta Supermarkets.

I hereby acknowledge that my employment is “at-will,” that I may resign at any time and the Company may terminate my employment at any time, with or without cause, and with or without notice, that any assurances of continued employment, whether written, oral or by conduct, shall not be interpreted as changing the nature of the employment relationship unless specifically acknowledged in writing by the President of the Company.

I declare under penalty of perjury that all the foregoing is true and correct

Note: No consideration of employment will be given to any applicant that does not sign the above statement. Application expires in 90 days if not employed.

FOR COMPANY USE ONLY

I hereby certify that I have been informed of the duties, the hours and days of work of the position for which I was offered and accepting.

Position

Orientation Date _____________________