Job Application

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Phone

When is the best time to contact you?

Position Applying for:

When could you start?

How did you hear about this job opening?

List Availability

Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday

Do you have any other outside commitments that may affect your availability?

Are you currently or have you been a working owner?

Yes
No

If yes, what department and what duration of time?

Have you ever been interviewed or employed at ACG

Yes
No

If yes, what department and what duration of time?

Are you legally eligible to be employed in this country?

Yes
No

Will you be able to furnish proof of employment eligibility upon hiring?

Yes
No

Are you at least 18 years of age?

Yes
No

Heavy lifting is a part of our business. Are you able to lift up to 50lbs?

Yes
No

Are you fluent in any Non-English languages?

Employment History

1. Current or Most Recent Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Position Held

Supervisor

First Last

Start Date

End Date

Currently Employed Here?

Yes

May we contact this person?

Duties Worked

Reason for leaving

2. Past Employer

Note: Past Employer information fields may be left blank if this information is included on an attached resume.

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Position Held

Supervisor

First Last

Start Date

End Date

May we contact this person?

Reason for leaving

3. Past Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Position Held

Supervisor

First Last

Start Date

End Date

May we contact this person?

Duties Worked

Reason for leaving

4. Past Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Position Held

Supervisor

First Last

Start Date

End Date

May we contact this person?

Duties Worked

Reason for leaving

Volunteer or Other Applicable Experience

Other Applicable Experience

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Position Held

Supervisor

First Last

Start Date

End Date

May we contact this person?

Duties Worked

Reason for leaving

Other Applicable Experience

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Position Held

Supervisor

First Last

Start Date

End Date

May we contact this person?

Duties Worked

Reason for leaving

Professional References

Reference 1: Name

First Last

Relation to you

Phone

Reference 2: Name

First Last

Relation to you

Phone

Reference 3: Name

First Last

Relation to you

Phone

Supplementary Questions

This section is designed to get to know a little bit more about you, but also for you to get to know a little bit more about us! Alberta Cooperative Grocery (ACG) is a collectively managed, consumer owned cooperative grocery. We are all managers here, and no one person is the boss- we are peers. We make decisions using a modified consensus model, a process in which we all must come to agreement before making a myriad of changes and decisions to store policy. This is an alternative work environment, and we welcome broad range of viewpoints and perspectives. Our mission is to serve as a community resource and gathering place, while providing fresh, high- quality, affordable food to the diverse members of North and Northeast Portland. We emphasize products from local, organic, and socially responsible sources, and work to build connections between our customers and their farmers. For more information about the work we do, please visit our website! Please take the time to thoughtfully and thoroughly answer all questions to the best of your abilities. If you need more space, please feel free to add or attach any additional information. We also have electronic copies of this application on our website, and we highly recommend that you type your application if your handwriting is difficult to read or if you would like more space to write.

What inspired you to apply for a position at ACG?

ACG is a rare work environment in which all staff have a voice and opportunity to participate in the processes that shape the co-op. Please describe your experiences in other organizations with high levels of staff participation, and describe how you made decisions. If you have any experience with consensus or modified consensus, please detail it here.

Many of our staff work in a variety of departments, teams and committees on a weekly basis. Please list your experience working in areas you think are relevant to working at ACG. Include instances in which you've had to balance varying workloads and responsibilities.

Do you have any applicable management or business experience in this or any other field?

Communication is vital in collectively managing a business. Please describe your style of giving feedback and tell us how you best receive feedback. Include any trainings or instances in which you participated in conflict resolution, mediation, or any other forms of alternative communication.

Co-op work, as well as customer service, can be uniquely challenging. Please describe your experience with difficult or challenging customer service situations, and how you react to and handle them.

Where do you see yourself in five years?

Signature of Applicant

Today's Date

Optional: Upload a resume and/or cover letter

Drop files here or

The Alberta Co-op is an equal opportunity employer. People of color, women, working-class, LGBTQI, and differently-abled persons are strongly encouraged to apply. We are committed to building and maintaining a diverse workplace, and aim to provide our staff with ongoing training and support.

Job Application

Employment History

Volunteer or Other Applicable Experience

Professional References

Supplementary Questions

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