Application For Employment

1500 NE Alberta Street Portland, OR 97211 503.287.4333

Name: _____________________________________________________ Date: _______________________

Address: _______________________________City: ________________ State: ________ Zip: _________
Daytime Phone: ____________________________ E-mail: _____________________________________
Position Applying for: ___________________________________________________________________
What date are you available to start?_______________________________________________________
What hours/days are you available?________________________________________________________
PAST AND CURRENT EMPLOYMENT (PLEASE ALSO SUBMIT A RESUME SPECIFYING DUTIES FOR EACH POSITION)
Current or Most Recent Employer __________________________________________________________
Address: _______________________________ City: _____________State: ______ Phone: __________
Position Held: _____________________ Supervisor: ______________ May we contact this person?______
Responsibilities: ________________________________________________________________________
Dates worked: ____________________ Reason For Leaving: ____________________________________
Past Employer __________________________________________________________________________
Address: _______________________________ City: _____________State: ______ Phone: __________
Position Held: _____________________ Supervisor: ______________ May we contact this person?______
Responsibilities: ________________________________________________________________________
Dates worked: ____________________ Reason For Leaving: ____________________________________
Past Employer ___________________________________________________________________________
Address: _______________________________ City: _____________State: ______ Phone: __________
Position Held: _____________________ Supervisor: ______________ May we contact this person?______
Responsibilities: ________________________________________________________________________
Dates worked: ____________________ Reason For Leaving: ____________________________________
Past Employer ___________________________________________________________________________
Address: _______________________________ City: _____________State: ______ Phone: __________
Position Held: _____________________ Supervisor: ______________ May we contact this person?______
Responsibilities: ________________________________________________________________________
Dates worked: ____________________ Reason For Leaving: ____________________________________
PROFESSIONAL REFERENCES
1. Name: _____________________________Relation to you:_________________ Phone:_____________
2. Name: _____________________________Relation to you:_________________ Phone:_____________
3. Name: _____________________________Relation to you:_________________ Phone:_____________
Received:

Comments:

Contacted:

Interviewed:

SUPPLEMENTARY QUESTIONS
We've come up with some questions that bear on the specific nature of working at the Alberta Cooperative Grocery. When
answering please feel free to add or attach whatever additional information you think is relevant. Please note that
applications without responses will not be considered.
1) The Alberta Co-op is a rare work environment where all staff have a voice and opportunity to participate in the processes
that shape the co-op. Describe your experiences in other organizations with high levels of staff participation, and describe
the type of decision making that was used. (Please include skills and/or experience with consensus.)
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2) Many of our staff cross-train in positions that involve working with produce, receiving and keeping track of orders,
organizing, training volunteers, and tracking department margins. Please list your experiences in these or any other areas
you think are relevant to working at the Alberta Cooperative Grocery.
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3) Communication is vital to maintaining healthy relationships with your co-workers. Please describe your style of giving
feedback and tell us how you best receive feedback. Wed also like to know if you have experience with conflict resolution
and/or mediation.
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4) Part of the Co-ops mission is to serve as a resource to the many different members of the N/NE community. What
personal and/or professional experience do you have working with diverse and changing communities (please include
language skills, community education work, as well as any relevant volunteer experience)?
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5) Co-op work, as well as customer service, can be uniquely challenging.
Describe your experience with
difficult/challenging situations and how you react to and handle them. (Please include your abilities to: provide customer
service, multi-task, handle emergency situations, and communicate with others -- and any other skills you have gained from
your experiences.)
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*Alberta Cooperative Grocery is an equal opportunity employer and will not discriminate on the basis of sex, age, race,
religion, marital status, gender, size, sexual orientation, national origin, or any other characteristic irrelevant to the good
execution of this position.
*Alberta Cooperative Grocery expects that the information you have provided above to be accurate to the best of your
knowledge.
T H A N K S F O R A P P LYI N G !