Position Applying For:
Social Security Number
Cell Phone Number
Hourly Wage Expected
Date Available for Employment
Are you 18 years or older?
Are you a citzen of the U.S. or do you have a legal right to work in the U.S.?
(Any offer of employment is conditional upon providing documents establishing identity and work authorization.)
Have you ever been convicted of a crime other than a minor traffic violation?
(Conviction of a crime will not automatically disqualify you from employment.)
If yes, when and where?
Nature and disposition of conviction:
What days are you available to work?
(Farmer's Markets will require set up and take down, with some lifting required.)
Monday hours available to work (If applicable).
Tuesday hours available to work (If applicable)
Wednesday hours available to work (If applicable)
Thursday hours available to work (If applicable)
Friday hours available to work (If applicable)
Saturday hours available to work (If applicable)
List all present and past employment, beginning with your most recent.
Company name/address/telephone number:
Your job title or position
Dates employed (From M/Y to M/Y)
Starting salary (hourly)
Present/Final salary (hourly)
If still employed, may we contact your present supervisor?
If yes, please give phone number
Reason(s) for leaving:
Describe your duties:
Did you graduate?
Dates Attended (M/Y - M/Y)
Major & Minor (if applicaple)
Please list below any job related accomplishments, professional distinctions, certifications or verifiable volunteer work:
Branch of Service
Dates of service (M/Y - M/Y)
By typing in your initials below, I affirm that I have read and understand this application, that I have not withheld any information requested, and that any statements I have made are true and correct. I understand that any omission or misrepresentation of fact in this application may result in refusal or separation from employment.
I authorize verification and investigation of the statements made on this application and of my employment history.
If I am accepted for employment, I understand and agree that such employment will be at will and may be terminated by either party at any time with reason or for no reason and with or without prior notice. I further understand and agree that this at-will employment status constitutes the entire understnading between me and the company regarding the right and ability of either party to terminate employment and that this at-will status cannot by changed except through a written understanding signed by the Manager of the Company.
Signature (Your initials)
Click to enter phone number