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Takoma Park Silver Spring Co-op • 201 Ethan Allen Ave • Takoma Park MD 20912 • 301-891-COOP (2667) • Open Mon-Sat 8 AM - 10 PM, Sun 9 AM - 9 PM

SUPER THURSDAY IS CHANGING! T.P.S.S. Co-op members will be able to use their 10% discount on ANY day once per month starting in January 2015! See our "Discount Name Contest" section for full details...

Online Employment Application for TPSS Co-op

Employment Application
NOTE PLEASE COMPLETE THIS ENTIRE FORM. INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED.
NOTE WE ARE AN EQUAL OPPORTUNITY EMPLOYER. WE DO NOT DISCRIMINATE ON THE BASIS OF RACE, RELIGION, COLOR, SEX, AGE, NATIONAL ORIGIN, MARITAL STATUS, OR DISABILITY.
NOTE DO YOU NEED AN ACCOMMODATION TO PARTICIPATE IN THE APPLICATION OR INTERVIEW PROCESS?  
Personal Data
Last Name:      First Name:        Mid Init: 
Address:      City:        State:        ZIP: 
Phone Number:        Email Address: 
Do you have a legal right to be employed in the United States of America? 
Are you under the age of 18?    If YES, Date of Birth:  
Have you ever been convicted of a felony?    If YES, please explain:

Position Information
Position Applying For:    I'm looking for
Why are you interested in this position?
When would you be available to start?
We are a retail business. We expect employees to work evenings and weekends.
Indicate the days and hours you are available to work:
  SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY
AM Shift:
MID DAY:
PM Shift:
Are there any limitations to your availablity that would keep you from showing up for your scheduled shift?

References (Persons who know about your work or training)
NAME RELATIONSHIP YEARS KNOWN PHONE

Present or Most Recent Employer
Employer:        From:        To: 
Address:        City:        State:        ZIP: 
Your Position:        Starting Salary:        Ending Salary: 
Duties:       
Supervisor's Name:        May we contact them?    
Phone Number:        Reason for leaving: 

Prior Employer
Employer:        From:        To: 
Your Position:        Starting Salary:        Ending Salary: 
Duties:       
Supervisor's Name:        May we contact them?    
Phone Number:        Reason for leaving: 

Prior Employer
Employer:        From:        To: 
Your Position:        Starting Salary:        Ending Salary: 
Duties:       
Supervisor's Name:        May we contact them?    
Phone Number:        Reason for leaving: 

Education
High School:      Attended From: To:
Did you graduate?    If you did NOT graduate, did you receive your GED?    
Technical, Vocational, College or University: 
Did you graduate?     Attended From: To:
Degree or Certification: Specialty:
Other Education: 
Did you graduate?     Attended From: To:
Degree or Certification: Specialty:

Additional Skills
How does the co-op / job fit into your current lifestyle?
Can you lift 50 pounds or more repetitively?    
Describe your skills for this position:

IT IS THE POLICY OF TAKOMA PARK SILVER SPRING FOOD COOP, INC (TPSS) TO PROVIDE EQUAL OPPORTUNITIES TO ALL QUALIFIED PERSONS WITHOUT REGARD TO RACE, COLOR, RELIGIOUS BELIEF, SEXUAL ORIENTATION, AGE, NATIONAL ORIGIN, PHYSICAL OR MENTAL HANDICAP, VETERAN STATUS, OR MARITAL STATUS.

BY ENTERING MY NAME AND CLICKING THE "SUBMIT" BUTTON I HEREBY CERTIFY THAT MY ANSWERS AND ASSERTIONS SET WITHIN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY ABILITY. IF I AM EMPLOYED I UNDERSTAND THAT ANY FALSE STATEMENTS ON THIS APPLICATION MAY BE CAUSE FOR MY IMMEDIATE DISMISSAL. I HEREBY AUTHORIZE THIS COMPANY TO INVESTIGATE MY PRIOR EDUCATION AND EMPLOYMENT HISTORY.

ENTER NAME: DATE: