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Have you ever been employed by Rosauers / Super 1 / Huckleberry's? *

Disclosure Statement

Please read carefully and initial below:

1. I certify that the information given in this application and in any attachments, supporting documents or interviews are (or will be) true and complete to the best of my knowledge. I understand that any falsification, misrepresentation or omission, as well as any misleading statements or omissions, generally will result in denial of employment, withdrawal of any offer of employment, or immediate termination, regardless of when and how discovered.

2. I authorize the investigation of all matters which Rosauers deems relevant to my qualifications for employment, including all information given in this application and in any attachments, supporting documents or interviews. I authorize you to request and receive such information and I release from all liability any persons (such as current or former supervisors, co-workers, etc.), employers or other such entities (schools, military, etc.) supplying it. I also release Rosauers Supermarkets, Inc. from all liability that might result from making the investigation.

3. I understand that I may resign or be terminated, without cause or notice, at any time, unless otherwise stated in a collective bargaining agreement or an employment contract. I also understand that the Vice‑President of Human Resources along with the President and CEO are the only persons who will ever have the authority to agree to any other terms and/or enter into such agreements or contracts and that all such agreements (collective bargaining agreements or agreements for other terms of employment) or contracts must be in writing and signed by both parties. I also understand that unless otherwise stated in a collective bargaining agreement or employment contract, the Company may change, withdraw and interpret other policies (including wages, hours and working conditions) as it deems appropriate.

4. I understand and agree that specifications pertaining to uniform, attire and personal appearance are at the discretion of the management.

5. Rosauers does not discriminate against applicants on the basis of disabilities unrelated to the essential functions of the job for which they are applying. In addition, Rosauers does not require that information relating to the physical or mental condition be disclosed in applying for employment. Preliminary offers of employment will be made without knowledge of, or regard to any applicant’s disability. You should understand that if you are offered a position in one of the job categories for which Rosauers does require a pre-employment medical examination, test, or imposes physical and other criteria to demonstrate through such examining or testing, that you are qualified (or with reasonable accommodation, would be qualified) to perform the essential functions of the job.

6. I understand and agree that I may be required to submit to pre- or post-employment physical or other professional examinations, medical inquiries and/or urinalysis tests for the presence of drugs and/or alcohol.

IMPORTANT: This means that with very few exceptions – for example, operations located in any state where it may be lawful – an employee will be required to submit to testing in several different circumstances. You may ask to see a copy of our employee Alcohol and Drug Policies if you have any questions. To be considered, you must agree to such examinations, inquiries and/or testing at the Company’s expense. By signing this application, you are authorizing release of the results to the Company and their use to evaluate your suitability for employment. You are releasing the Company from all liability arising out of, or connected with any examinations, inquiries and/or testing.

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