SPROUTS CHULA VISTA & EASTLAKE
Application for Employment


An Equal Opportunity Employer - All employment decisions are made without regard to unlawful considerations of race, religion (all aspects of religious beliefs, observance or practices, including religious dress or grooming practices), color, national origin (including language use restrictions and possession of a driver’s license issued under Vehicle Code section 12801.9), ancestry, physical disability, mental disability, medical condition, marital status, sex (including pregnancy, childbirth, breastfeeding or related medical conditions), gender (including gender identity and gender expression) genetic characteristic, sexual orientation, registered domestic partner status, age, military or veteran status, or any other basis protected by federal, state or local law or ordinance or regulation.


All fields with * must be filled out.
Date Position Location
APPLICATION DATA
Last Name * First Name * Middle Name *
Address* City*
State* Zip*
Phone* Date Available to Start*
If you are under the age 18 and require a work permit, can you furnish one? *
If no, please explain:
Have you ever worked for Sprouts Farmers Market? *
If yes, when?
Are you legally authorized to work for any employer in the United States?
(Proof of employment authorization status will be required)
If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country?
Who referred you to Sprouts Farmers Market?
Type of employment desired:? *
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accomodation?
If no, describe the functions that cannot be performed.
(Note: We comply with the ADA and consider resonable accomodation measures that may be necessary for eligible applicants/employees to perform essential functions).
*
If employed, do you also expect to work elsewhere?
If employed, what hours would you be available to work *
MON TUE WED THU FRI SAT SUN
 
EDUCATION
High School Address
Number of Years Completed Did You Graduate?
College/University Address
Number of Years Completed Did You Graduate?
Other: Address
Number of Years Completed Did you Graduate?
 
REFERENCES
Professional/Personal References (3 Minimum) Name, Phone Number, Address & Relation
  NAME PHONE NUMBER ADDRESS RELATION
1
2
3
4
SUMMARIZE YOUR SPECIAL SKILLS OR QUALIFICATIONS *
 
WORK EXPERIENCE
Dates* Position(s) Held:*
Firm Address*
Phone Supervisor*
Title
Responsabilities
Reason for Leaving: *
Dates* Position(s) Held:*
Firm Address*
Phone Supervisor*
Title
Responsabilities
Reason for Leaving: *
Dates Position(s) Held:
Firm Address
Phone Supervisor
Title
Responsabilities
Reason for Leaving:
 
CERTIFICATION AND ACKNOWLEDGEMENT
I certify that the information provided in this Application for Employment, and in any resume or other materials I am submitting with it, is true correct to the best of my knowledge. I understand that false or incomplete statements, or any misleading or incorrect statements, shall be considered sufficient reason for the rejection of this application of dismissal if employed. I authorize the Company and its agents to contact the persons and organizations I have listed herein in order to confirm the information provided and further evaluate my job-related skills, experience, and employment eligilbility. I authorize all individuals, schools, firms, agencies and employers to release all requested information and documents. I release the Company and its agents, and the persons and entities who provide information to them, from all claims, liability and damages arising out of the provision of information or documents as authorized by this paragraph.

Should a search of "public records" (defined as records documenting an arrest, indictment, conviction, civil juditioal action, tax lien or outstanding judgment) be conducted by internal personnel employed by the Company, I am entitled to copies of any such public records obtained by the Company unless I mark the check box below.
I waive receipt of a copy of any "public records" described in the paragraph above.
I understand that if employed, my employment with the Company is "at will," which means that it may be terminated at any time, with or without cause or advance notice, by either me or the Company. This employment at will agreement constitues the entire agreement between you and the Company on the subject or termination and can only be modified by an express written agreement signed by you and the President of the Company.

Signature*