First Name*
Last Name*
Middle Initial
Street Address*
City, State, Zip Code*
Date of Birth*
Telephone Number*
Email*
Position Applying For
Full Time/Part Time
Date Available
Desired Pay
Are you able to perform the essential job functions of the position you are applying for with or without reasonable accommodations? YesNo
If hired, are you willing to work overtime if needed? YesNo
Are you at least 18 years of age? YesNo
If you are under 18, do you have a work permit? YesNo
Have you ever been convicted of a crime, excluding misdemeanors and summary offenses, which has not been annulled, expunged or sealed by court? a yes doesn't automatically disqualify your application. If yes, please explain. YesNo
High School
Address
Year Graduated
College/University
Major Studies
Degree, date
Vocation, Business, Other Education
Degree, License/Certificate, date
Graduate School
Other special knowledge, skills or qualifications
Military Service (list dates, ranks)
Honorable Discharge? YesNo
List all employers, starting with the most recent position. You may attach a resume, but not in place of completing the required information.
Employed From
Employed To
Job Title
Salary
Employer Name
Supervisor's Name
Supervisor's Phone
Job Duties and Responsibilities
Is this your current employer? YesNo
May we contact this employer for reference? YesNo
Reason for Leaving?
Volunteer Activities - Optional (list organization, type of service, dates) Hobbies, Interests - Optional
The above information is true and correct. I authorize Ernessi Farms to inquire into my education, past employment history, and references as needed to research my qualifications for this position. If employed, I will be required to provide original documents which verify my identity and right to work in the United States under the Immigration Reform and Control Act (IRCA) of 1986. The document(s) provided will be used the completion of Form I-9. I hereby acknowledge that I have read and agree to the above statements.
Signature
Date
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