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Full Name :  
Street Address :
City :
State :
Zip Code :
Phone Number :
For which position are you applying?  
If hired, what pay rate do you desire per hour?
Are You under 18 years of age?
Yes No
Please state your date of birth :
Please indicate what hours you are available to work?
Mon Tue Wed Thur Fri Sat Sun
From
To
Are you willing to work on holidays?
Yes No
Are you willing to work on weekends (Sat-Sun)?
Yes No
Would you work Full- Time or Part-Time?
FT PT
Would You prefer day or evening shifts?
Day Evening
If hired, when can you start? (DATE)
Number of hours available per week :
Minimum Maximum
JOB INTEREST
We require our employees to work as a team, respect each others individually, have fun , and make customers feel welcome. Are you willing to go along with this?
Yes No
If hired, are there any obligations which would prevent you from reporting to work each day on time to perform your job duties?
Yes No
Have you ever been employed by any other Indian grocery store or Indian Food Retailor business in USA?
Yes No
If Yes , Please provide dates of employment :
From mm/yy To mm/yy
Name of store :
Name of Manger :
Why did you leave?
Are you now in school or taking courses?
Yes No
If Yes School Name :
When will you finish the program?
Course hours you are committed to per week :
Basic Computer knowledge?
Yes No
If Yes rate yourself :
1 2 3 4 5
Emergency Contact Name :
Phone :
Are You eligible to work in USA?
If No, please tell your current legal status :
We have a no cell phone policy within the store. Are you willing to go along with this?
Are you open to work at all locations of India Bazaar?
Main Reason for this job:
Your preferred IB location :  
I certify that information contained in this application is true and complete.

I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.
Signature :
Date :

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