Application for Employment Please Fill Out the Following Information: Equal access to programs, services, and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department. Position(s) applied for: * Location of Desired Employment: Mount Olive, NC Newton Grove, NC Full Service Catering (Seasonal & Weekends) Shift(s) Desired: Select All that Apply. Day Shift Night Shift Saturday Morning Shift Date of Application: * MM DD YYYY Name * First Name Last Name Address: * Phone Number * Email * If you are under 18, and it is required, can you furnish a work permit? * Yes No N/A If no, please explain: * Have you ever been employed here before? * Yes No If yes, give dates and positions: * Are you legally eligible for employment in this country? * Yes No Date available for work: * MM DD YYYY Type of employment desired: * Full-Time Part-Time Are you able to meet the attendance requirements of the position? * Yes No Have you ever pled "guilty" or "no contest" to, or been convicted of, a crime? * Yes No Answering "Yes" to these questions does not constitute an automatic bar to employment. Factors such as date of offense, seriousness and nature of violation, rehabilitation, and position applied for will be taken into account. If Yes, please provide date(s) and details: * Employment History: Provide the following information for your past (4) employers, assignments or volunteer activities starting with most recent. If you have only had 1-3, please place N/A in all the required fields you cannot complete. Job #1 (If applicable) From: * MM DD YYYY To: MM DD YYYY Employer: * Phone Number: * Starting Job Title: * Final Job Title: * Immediate Supervisor and Title: * Summary of Work Performed and Job Responsibilities: * May we contact for reference? * Yes No Reason for Leaving: * Starting Rate/Salary: * Final Rate/Salary: * Job #2 (If applicable) From: * MM DD YYYY To: MM DD YYYY Employer: * Phone Number: * Starting Job Title: * Final Job Title: * Immediate Supervisor and Title: * Summary of Work Performed and Job Responsibilities: * May we contact for reference? * Yes No Reason for Leaving: * Starting Rate/Salary: * Final Rate/Salary: * Job #3 (If applicable) From: * MM DD YYYY To: MM DD YYYY Employer: * Phone Number: * Starting Job Title: * Final Job Title: * Immediate Supervisor and Title: * Summary of Work Performed and Job Responsibilities: * May we contact for reference? * Yes No Reason for Leaving: * Starting Rate/Salary: * Final Rate/Salary: * Job #4 (If applicable) From: * MM DD YYYY To: MM DD YYYY Employer: * Phone Number: * Starting Job Title: * Final Job Title: * Immediate Supervisor and Title: * Summary of Work Performed and Job Responsibilities: * May we contact for reference? * Yes No Reason for Leaving: * Starting Rate/Salary: * Final Rate/Salary: * Skills and Qualifications Summarize any training, skills, licenses and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying. * References (You Must Provide Three) Reference #1 Name * First Name Last Name Telephone Number * Number of Years Known: * Reference #2 Name * First Name Last Name Telephone Number * Number of Years Known: * Reference #3 Name * First Name Last Name Telephone Number * Number of Years Known: * Applicant Statement: Please Read the Following: I certify that all information I have provided to apply for and secure work with the employer is true, complete, and correct. I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application or (ii) immediately discharge me from the employer's service, whenever it is discovered. I expressly authorize, without reservation, the employer, its representatives, employees, or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees, or representatives for seeking, gathering, and using such information in the employment process and all other persons, corporations, or organizations for furnishing such information about me. I understand that the employer does not unlawfully discriminate in employment, and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state, or federal law. I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application. If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral, or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president. I also understand that if I am hired I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete I-9 Form in this regard. Do not sign until you have read the above applicant statement. I certify that I have read, fully understand, and accept all terms of the foregoing Applicant Statement. Yes No Signature * Date MM DD YYYY Thank you! We will be in touch soon! The Farm House Management
