Brookhaven Marketplace is an equal employment opportunity employer. Our company will provide reasonable accommodations with the application process upon your request consistent with applicable laws.

Personal Information:

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Employment Desired:


Availability:

(Please list your availability to work)

MON

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WED

THURS

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SUN


Education:

NAME & LOCATION OF SCHOOL




Employment Experience:

(Please list your employment experience, starting with the most recent first.)

(Brookhaven Marketplace will only contact current employer only if you consent. Our Company reserves the right to contact the other employers listed without any further notice to you.)


Dates of Employment
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Phone

Salary

Position/Duties

Reason for Leaving





General Information:


References:

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PLEASE READ CAREFULLY BEFORE SIGNING

I certify that all the information submitted by me on this application is true, correct and complete. I understand that if any false information, omissions, or misrepresentations on this form or provided in any interview are discovered, my application may be rejected, and, if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company’s rules, regulations and Supervisor’s directions. I understand that this Application forEmployment and other Company documents are not contracts of employment. I agree that if I am employed, my employment is at-will, and that my employment, compensation or benefits can be changed or terminated, with or without cause or reason, and with or without notice, at either my or the company’s option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause or reason, and with or without notice, at any time by the company. I understand that no company representative, other than the President, and then only in writing and signed by both of us, has any authority to enter into any agreement foremployment for any specific period of time or to make any agreement contrary to the forgoing. I further authorize the Company to investigate my references, personal history, work record, and other matters related to my suitability for employment, as well as credit or criminal records checking. I authorize all of this information to be provided to the company or their agent and release them from any and all claims, demands or liability arising out of or in any way related to such investigation or disclosure. I understand that if hired, I may be required to pass a criminal history records check. Also, if required, I agree to complete, fully participate in and pass a drug and/or alcohol test. Please note that this application is considered current for 30 days. After 30 days, it is necessary to complete another application form to be considered for employment

Date:

12/18/2018

By providing your name in the above box, you are signing this document.

  • Size

    lb

    Identifier

    00000000000215

    SKU/UPC

    21

    Brand

    Fresh
  • Size

    10 pieces

    Description

    Black plastic plates, forks, knives & napkins for ten guests.

    Identifier

    00205093000009

    SKU/UPC

    20509300000
  • Size

    3.5 oz

    Description

    Gourmet quinoa snack. Vegan. Non GMO Project verified. nongmoproject.org. Certified gluten-free. Good source of 5 g protein per serving. Simple ingredients. Simply delicious. What are Quinoa Curls? We take the ancient grain, quinoa, and bake its flavors & benefits into a bite-sized snack. Paired with your favorite dips, these simply delicious snacks offer a healthier crunch. Welcome to your new favorite chip! 7 Simple Standards: At Simply 7, we're passionate about making great-tasting, wholesome snacks for every lifestyle! We make all of our chips delicious, nutritious, and in line with our 7 simple standards. Keep snacking simply! - The Simply 7 Team. Clean ingredients. No added preservatives. 0 grams trans fat. No artificial colors or flavors. Gluten free. Simple ingredients. Simply delicious. Facebook. Instagram. For great recipes and more, visit simply7snacks.com. Good source of 5 g protein. Manufactured in a peanut and treenut free facility. Made in the USA.

    Identifier

    00764218655468

    SKU/UPC

    76421865546

    Manufacturer

    Simply 7 Snacks

    Brand

    Simply 7
  • Size

    2 pieces

    Identifier

    00205094000008

    SKU/UPC

    20509400000
  • Size

    1 pk

    Description

    Driscoll's® Strawberries. Only the finest berries™. Net Wt 16 oz (1lb). www.driscolls.com.

    Identifier

    00715756200023

    SKU/UPC

    71575620002

    Manufacturer

    Driscoll Strawberry Associates, Inc.

    Brand

    Driscoll's
  • Size

    ea

    Identifier

    00000000000185

    SKU/UPC

    18

    Brand

    Fresh
  • Size

    1 pk

    Identifier

    00715756200023

    SKU/UPC

    71575620002
  • Size

    2 pieces

    Identifier

    00205095000007

    SKU/UPC

    20509500000
  • Size

    ea

    Description

    Nigiri fanatics! Don't miss this fantastic mixture of Nigiri Sushi. Features tuna, white tuna, salmon, shrimp, eel and yellow tail tuna.

    Identifier

    00859521004413

    SKU/UPC

    85952100441

    Brand

    Sushi Osaka
  • Size

    ea

    Description

    Stainless steel chafer including two warming gels and steel serveware. One day rental.

    Identifier

    00205096000006

    SKU/UPC

    20509600000
  • Size

    ea

    Identifier

    00000000000628

    SKU/UPC

    62

    Brand

    Fresh
  • Size

    ea

    Description

    Wire stand, aluminum water pan & two warming gels.

    Identifier

    00205091000001

    SKU/UPC

    20509100000
  • Size

    ea

    Description

    Two hour warming gel can.

    Identifier

    00205097000005

    SKU/UPC

    20509700000
  • Size

    1 pk

    Description

    Driscoll's® Raspberries. Only the finest berries™. Net Wt 6 oz. Patent pending. Visit: www.driscolls.com.

    Identifier

    00715756100019

    SKU/UPC

    71575610001

    Manufacturer

    Driscoll Strawberry Associates, Inc.

    Brand

    Driscoll's
  • Size

    ea

    Identifier

    00205089000006

    SKU/UPC

    20508900000
  • Size

    lb

    Identifier

    00000000000529

    SKU/UPC

    52

    Brand

    Fresh
  • Size

    18 sandwiches

    Identifier

    00205082000003

    SKU/UPC

    20508200000
  • Size

    48 pieces

    Description

    Delicious vegetarian Spring Rolls, featuring avocado, cucumber, carrots and green leaf asparagus with sweet and sour chili sauce.

    Identifier

    00207987000003

    SKU/UPC

    20798700000
  • Size

    serves 10-14

    Identifier

    00205144000002

    SKU/UPC

    20514400000
  • Size

    lb

    Identifier

    00000000000475

    SKU/UPC

    47

    Brand

    Fresh
  • Size

    3.5 oz

    Description

    Gourmet quinoa snack. Good source of 5 g protein per serving. Non GMO Project verified. Nongmoproject.org. Certified gluten-free. Clean ingredients. No added preservatives. 0 grams trans fat. No artificial colors or flavors. Manufactured in a peanut and treenut free facility. Simple ingredients. Simply delicious. What are the quinoa curls? We take the ancient grain, quinoa, and bake its flavors & benefits into a bite-sized snack. Paired with your favorite dips, these simply delicious snacks offer a healthier crunch. Welcome to your new favorite chip! 7 Simple Standards: At Simply 7, we're passionate about making great-tasting, wholesome snacks for every lifestyle! We make all of our chips delicious, nutritious, and in line with our 7 simple standards. Keep snacking simply! The Simply 7 Team. Facebook. Instagram. For great recipes and more, visit simply7snacks.com.

    Identifier

    00764218655475

    SKU/UPC

    76421865547

    Manufacturer

    Simply 7 Snacks

    Brand

    Simply 7
  • Size

    lb

    Identifier

    00000000003261

    SKU/UPC

    326

    Brand

    Fresh
  • Size

    serves 10-14

    Identifier

    00205099000003

    SKU/UPC

    20509900000
  • Size

    lb

    Identifier

    00000000002912

    SKU/UPC

    291

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000002233

    SKU/UPC

    223

    Brand

    Fresh
  • Size

    500 ct

    Identifier

    00000000002554

    SKU/UPC

    255

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000003186

    SKU/UPC

    318

    Brand

    Fresh
  • Size

    lb

    Identifier

    00209274000000

    SKU/UPC

    20927400000

    Brand

    Grade A
  • Size

    ea

    Identifier

    00000000002400

    SKU/UPC

    240

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000001410

    SKU/UPC

    141

    Brand

    Fresh
  • Size

    lb

    Identifier

    00209086000007

    SKU/UPC

    20908600000

    Brand

    U.S.G.I.
  • Size

    lb

    Identifier

    00000000000079

    SKU/UPC

    7

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000940115

    SKU/UPC

    94011

    Brand

    Organic
  • Size

    ea

    Identifier

    00000000002370

    SKU/UPC

    237

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000001397

    SKU/UPC

    139

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000000840

    SKU/UPC

    84

    Brand

    Fresh
  • Size

    10 oz

    Description

    For Mexican soft tacos, table use, appetizers & snacks. 100% natural. The fame is in the name and the quality in the product. No preservatives. El Milagro corn tortillas are the best quality tortillas made. When our tortillas are heated they get just as soft as when they were freshly baked. Our tortillas actually enhance the flavor of your food. El Milagro corn tortillas are the best for natural soft tacos, or at the table with a Mexican meal and all types of appetizers and snacks.

    Identifier

    00038622621174

    SKU/UPC

    3862262117

    Manufacturer

    El Milagro

    Brand

    El Milagro
  • Size

    lb

    Identifier

    00000000002219

    SKU/UPC

    221

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000003124

    SKU/UPC

    312

    Brand

    Fresh
  • Size

    84 - 1.6 oz

    Identifier

    00000000002301

    SKU/UPC

    230

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000001403

    SKU/UPC

    140

    Brand

    Fresh
  • Size

    128 oz

    Description

    37% less fat than milk. Fat reduced from 8 g to 5 g per serving. Pasteurized. Grade A. Homogenized. Vitamin A & D. Our farmers pledge not to treat their cows with artificial growth hormones (The FDA has determined that no significant difference has been shown between milk derived from artificial growth hormone treated and non-artificial growth hormone treated cows). Farmer owned. Our Caps Your Cause. Go to: PrairieFarms.com. www.prairiefarms.com.

    Identifier

    00072730221109

    SKU/UPC

    7273022110

    Manufacturer

    Prairie Farms Dairy

    Brand

    Prairie Farms
  • Size

    ea

    Identifier

    00000000002417

    SKU/UPC

    241

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000003599

    SKU/UPC

    359

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000031202

    SKU/UPC

    3120

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000001113

    SKU/UPC

    111

    Brand

    Fresh
  • Size

    ea

    Identifier

    00000000002653

    SKU/UPC

    265

    Brand

    Fresh
  • Size

    ea

    Identifier

    00859521004512

    SKU/UPC

    85952100451

    Brand

    Sushi Osaka
  • Size

    16 oz

    Description

    Cuisine De France Parisian French Bread. A classic French bread. Thin and crispy crust with a wonderful flavor. Plenty to share with friends and family. Oven fresh bread. Parisian bread. Congratulations and thanks you! You have chosen a cuisine de France product baked fresh every day right here in your favorite store. We take great care in making this loaf of bread and use the best recipes and finest ingredients. The product is best consumed on day of purchase. If you have any questions or comments please call us at 847-69-3837.

    Identifier

    00667121000366

    SKU/UPC

    66712100036

    Manufacturer

    Cuisine de France Inc.

    Brand

    Cuisine de France
  • Size

    12 ct

    Identifier

    00070253699825

    SKU/UPC

    7025369982

    Brand

    Our Family
  • Size

    lb

    Identifier

    00000000000093

    SKU/UPC

    9

    Brand

    Michigan
  • Size

    ea

    Identifier

    00000000002318

    SKU/UPC

    231

    Brand

    Fresh
  • Size

    lb

    Identifier

    00209430000004

    SKU/UPC

    20943000000

    Brand

    Usda
  • Size

    ea

    Identifier

    00000000002264

    SKU/UPC

    226

    Brand

    Fresh
  • Size

    16 oz

    Identifier

    00063051206005

    SKU/UPC

    6305120600

    Brand

    Brookhavens
  • Size

    16 oz

    Identifier

    00000000001373

    SKU/UPC

    137

    Brand

    Driscolls
  • Size

    lb

    Identifier

    00000000002899

    SKU/UPC

    289

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000003223

    SKU/UPC

    322

    Brand

    Fresh
  • Size

    6 oz

    Description

    US No. 1. Pure Michigan. www.northbayproduce.com. USDA researchers have identified the blueberry as the top defender for body cells against free radicals which cause aging and diseases in the body, among 30 fruits and vegetables studied. Source: North American Blueberry Council. www.blueberry.org. Blueberries: Little blue dynamos. Product of USA.

    Identifier

    00000000001533

    SKU/UPC

    153

    Manufacturer

    North Bay Produce

    Brand

    North Bay Produce
  • Size

    lb

    Identifier

    00000000002295

    SKU/UPC

    229

    Brand

    Fresh
  • Size

    ea

    Identifier

    00000000000611

    SKU/UPC

    61

    Brand

    Fresh
  • Size

    16 oz

    Identifier

    00000000002288

    SKU/UPC

    228

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000001267

    SKU/UPC

    126

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000002028

    SKU/UPC

    202

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000000642

    SKU/UPC

    64

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000003339

    SKU/UPC

    333

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000003162

    SKU/UPC

    316

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000003407

    SKU/UPC

    340

    Brand

    Fresh
  • Size

    ea

    Identifier

    00046135480195

    SKU/UPC

    4613548019

    Brand

    Brookhavens
  • Size

    ea

    Identifier

    00000000002875

    SKU/UPC

    287

    Brand

    Fresh
  • Size

    lb

    Identifier

    00206302000001

    SKU/UPC

    20630200000

    Brand

    Krakus
  • Size

    lb

    Identifier

    00209299000009

    SKU/UPC

    20929900000

    Brand

    Grade A
  • Size

    lb

    Identifier

    00000000001052

    SKU/UPC

    105

    Brand

    Fresh
  • Size

    3 pk

    Identifier

    00000000002721

    SKU/UPC

    272

    Brand

    Fresh
  • Size

    3 lb

    Identifier

    00000000003773

    SKU/UPC

    377

    Brand

    Fresh
  • Size

    0.88 oz

    Description

    Dispose of properly. Food safe. www.stark.rs. Country of Origin: Republic of Serbia.

    Identifier

    08600939365700

    SKU/UPC

    860093936570

    Manufacturer

    Stark

    Brand

    Stark
  • Size

    lb

    Identifier

    00209327000001

    SKU/UPC

    20932700000

    Brand

    Honeysuckle
  • Size

    lb

    Identifier

    00209194000005

    SKU/UPC

    20919400000

    Brand

    Brookhavens
  • Size

    ea

    Identifier

    00000000002967

    SKU/UPC

    296

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000002936

    SKU/UPC

    293

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000003216

    SKU/UPC

    321

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000000048

    SKU/UPC

    4

    Brand

    Fresh
  • Size

    2.82 oz

    Identifier

    00000000005579

    SKU/UPC

    557

    Brand

    Brookhavens
  • Size

    lb

    Identifier

    00000000002165

    SKU/UPC

    216

    Brand

    Fresh
  • Size

    ea

    Identifier

    00000000002684

    SKU/UPC

    268

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000001069

    SKU/UPC

    106

    Brand

    Fresh
  • Size

    lb

    Identifier

    00209287000004

    SKU/UPC

    20928700000

    Brand

    Grade A
  • Size

    128 oz

    Description

    Vitamin D. Pasteurized. Grade A. Homogenized. Our farmers pledge not to treat their cows with artificial growth hormones (The FDA has determined that no significant difference has been shown between milk derived from artificial grown hormone treated and non-artificial growth hormone treated cows). Farmer owned. Our Caps Your Cause. Go to: PrairieFarms.com. www.prairiefarms.com.

    Identifier

    00072730211100

    SKU/UPC

    7273021110

    Manufacturer

    Prairie Farms Dairy

    Brand

    Prairie Farms
  • Size

    lb

    Identifier

    00209085000008

    SKU/UPC

    20908500000

    Brand

    U.S.G.I.
  • Size

    24 pk 16.9 oz

    Description

    24 - 0.5 liter. 30% less plastic (Bottle contains an average 30% less plastic versus comparable size carbonated and non-carbonated beverages. For more information, visit icemountainwater.com/ecoshape). Pure quality. Please recycle. Questions? Comments? Call 1-800-678-4Ice.

    Identifier

    00083046004027

    SKU/UPC

    8304600402

    Manufacturer

    Nestle Waters

    Brand

    Ice Mountain
  • Size

    lb

    Identifier

    00209143000001

    SKU/UPC

    20914300000

    Brand

    U.S.G.I.
  • Size

    ea

    Identifier

    00890592002007

    SKU/UPC

    89059200200

    Brand

    L Frances
  • Size

    lb

    Identifier

    00000000000024

    SKU/UPC

    2

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000001298

    SKU/UPC

    129

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000002479

    SKU/UPC

    247

    Brand

    Fresh
  • Size

    ea

    Identifier

    00000000001342

    SKU/UPC

    134

    Brand

    Fresh
  • Size

    lb

    Identifier

    00000000002868

    SKU/UPC

    286

    Brand

    Fresh
  • Size

    ea

    Identifier

    00000000002394

    SKU/UPC

    239

    Brand

    Fresh
  • Size

    12 oz

    Description

    The fame is in the name and the quality is in the product. El Milagro Flour Tortillas are the best quality tortillas made. When our tortillas are heated, they become just as soft as when freshly baked. Our tortillas actually enhance the flavor of your food. El Milagro Flour Tortillas are the best for natural soft tacos, or at the table with a Mexican meal, and for all types of appetizing snacks. Founded 1950 by Raul Lopez Sr.

    Identifier

    00038622624472

    SKU/UPC

    3862262447

    Manufacturer

    El Milagro

    Brand

    El Milagro
  • Size

    ea

    Identifier

    00202997000005

    SKU/UPC

    20299700000

    Brand

    Brookhavens