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Market Basket Employment Application Form

PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE Page 1 of 2

APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS

DATE

Name

Last First Middle Maiden

Present address

Number Street City State Zip

How long at above address: Social Security No. – –

Telephone: Home- Cell- Work-

If under 18, please list age

How many hours can you work weekly? Can you work nights?

Employment desired FULL-TIME ONLY PART-TIME ONLY FULL- OR PART-TIME

Date available for work?

Are you a U.S. Citizen or otherwise authorized to work in the United States on an unrestricted basis? No Yes

If applicable, please list your visa type, visa number and expiration date:

EDUCATION

TYPE OF SCHOOL NAME OF SCHOOL LOCATION # OF YEARS MAJOR &

(Complete mailing address) COMPLETED DEGREE

High School

College

Bus. or Trade School

Professional School

HAVE YOU EVER BEEN CONVICTED OF A CRIME? No Yes

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were

committed, sentence(s) imposed, and type(s) of rehabilitation.

Please list two references that are not relatives or previous employers.

Name Name

Address Address

Telephone Telephone Work Experience

Employer Name Name of last supervisor Employment Pay or salary

and Address dates

City, State, Zip Code

From Start

To Final

Phone number Job title / Duties

Reason for leaving (be specific)

Employer Name Name of last supervisor Employment Pay or salary

and Address dates

City, State, Zip Code

From Start

To Final

Phone number Job Title / Duties

Reason for leaving (be specific)

Work Experience

Employer Name Name of last supervisor Employment Pay or salary

and Address dates

City, State, Zip Code

From Start

To Final

Phone number Job title / Duties

Reason for leaving (be specific)

Employer Name Name of last supervisor Employment Pay or salary

and Address dates

City, State, Zip Code

From Start

To Final

Phone number Job Title / Duties

Reason for leaving (be specific)

May we contact your present employer? Yes No

Did you complete this application yourself Yes No

If not, who did?

PLEASE READ CAREFULLY

APPLICATION FORM WAIVER

In exchange for the consideration of my job application by Market Basket I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position

applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy

statements, and the like as they may exist from time to time, or other Market Basket practices, shall serve to create an actual or

implied contract of employment, or to confer any right to remain an employee of Market Basket, or otherwise to change in any

respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a

written instrument signed by managers of Market Basket. Both the undersigned and Market Basket may end the employment

relationship at any time, without specified notice or reason. If employed, I understand that Market Basket may unilaterally change

or revise their benefits, policies and procedures and such changes may include reduction in benefits and wages.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts

called for is cause for dismissal at any time without any previous notice. I hereby give the Market Basket permission to contact

schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Market Basket from any

liability as a result of such contact.

I further understand that my employment with Market Basket shall be probationary for a period of one hundred eighty (180) days,

and further that at any time during the probationary period or thereafter, my employment relation with Market Basket terminable at

will for any reason by either party.

Applicant Signature: Date:

Market Basket is an equal employment opportunity employer. We adhere to a policy of making employment decisions without

regard to race, color, national origin, religion, sex, sexual orientation, marital status, citizenship, military service membership, age

or disability. We assure you that your opportunity for employment with Market Basket depends solely on your qualifications.

Thank you for completing this application form and for your interest in employment with Market Basket.

Contact this candidate