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Application for Employment

PERSONAL DATA
* NAME (LAST, FIRST, MI)
 * TODAY'S DATE
IF PAST EMPLOYMENT OR EDUCATION RECORDS ARE UNDER ANOTHER NAME, PLEAST STATE THAT NAME
 * CURRENT TELEPHONE NUMBER
* CURRENT ADDRESS (INCLUDE STREET, CITY, STATE AND ZIP CODE)
 * E-MAIL ADDRESS
* ARE YOU AT LEAST 18 YEARS OF AGE OR OLDER?
Yes   No (If you are under 18, a work permit is required) 		* DID YOU GRADUATE FROM HIGH SCHOOL?
Yes   No
* HAVE YOU EVER BEEN CONVICTED OF A FELONY OR OTHER SERIOUS CRIME?
If "yes", please provide dates and details. (Answering "yes" does not constitute an automatic bar to employment and will be considered only as it relates to the position in which you are applying.)
Yes   No
* IN THE PAST 3 YEARS, HAVE YOU USED ANY NARCOTICS, AMPHETAMINES, OR BARBITURATES, OTHER THAN THOSE PRESCRIBED TO YOU BY A PHYSICIAN?
(Prior drug use will not disqualify you from consideration if you have been rehabilitated and are not currently using illegal drugs.)
Yes   No
* ARE YOU LEGALLY ELIGIBLE TO WORK IN THE UNTED STATES?
Yes   No
* REFERRAL SOURCE
Advertisement    Country Fresh Employee    Walk-In   
Employment/Staffing Agency    Internet/Website    Other   
* POSITION(S) FOR WHICH YOU ARE APPLYING
* SALARY/WAGE DESIRED
 * TYPE OF EMPLOYMENT YOU SEEK
 * SHIFT PREFERENCE
 * DATE AVAILABLE
EDUCATION
HIGH SCHOOL
DIPLOMA OR DEGREE RECEIVED
Yes   No 		COURSE OF STUDY
COLLEGE
DIPLOMA OR DEGREE RECEIVED
Yes   No 		COURSE OF STUDY
OTHER COLLEGE, TECHNICAL, BUSINESS, GRADUATE OR SPECIAL MILITARY TRAINING
DIPLOMA OR DEGREE RECEIVED
Yes   No 		COURSE OF STUDY
EMPLOYMENT HISTORY
Please list your employment history for the previous 10 years, starting with the most current or most recent employer, including any periods of military service, summer or seasonal employment, self-and/or unemployment. Please attach additional paper if you need more space to give your employment history.

NOTICE: If your resume is provided as a supplement to this Application form, this page/entire section still needs to be completed (even though some of this information may already be included on your resume).
EMPLOYER #1
FROM
 TO
EMPLOYER 1 INFORMATION
SUMMARIZE THE NATURE OF WORK PERFORMED AND JOB RESPONSIBILITIES
JOB TITLE
IMMEDIATE SUPERVISOR AND TITLE
MAY WE CONTACT FOR A REFERENCE?
Yes   No   Later
REASON FOR LEAVING
HOURLY RATE/SALARY?
EMPLOYER #2
FROM
 TO
EMPLOYER 2 INFORMATION
SUMMARIZE THE NATURE OF WORK PERFORMED AND JOB RESPONSIBILITIES
JOB TITLE
IMMEDIATE SUPERVISOR AND TITLE
MAY WE CONTACT FOR A REFERENCE?
Yes   No   Later
REASON FOR LEAVING
HOURLY RATE/SALARY?
EMPLOYER #3
FROM
 TO
EMPLOYER 3 INFORMATION
SUMMARIZE THE NATURE OF WORK PERFORMED AND JOB RESPONSIBILITIES
JOB TITLE
IMMEDIATE SUPERVISOR AND TITLE
MAY WE CONTACT FOR A REFERENCE?
Yes   No   Later
REASON FOR LEAVING
HOURLY RATE/SALARY?
EMPLOYER #4
FROM
 TO
EMPLOYER 4 INFORMATION
SUMMARIZE THE NATURE OF WORK PERFORMED AND JOB RESPONSIBILITIES
JOB TITLE
IMMEDIATE SUPERVISOR AND TITLE
MAY WE CONTACT FOR A REFERENCE?
Yes   No   Later
REASON FOR LEAVING
HOURLY RATE/SALARY?
EMPLOYER #5
FROM
 TO
EMPLOYER 5 INFORMATION
SUMMARIZE THE NATURE OF WORK PERFORMED AND JOB RESPONSIBILITIES
JOB TITLE
IMMEDIATE SUPERVISOR AND TITLE
MAY WE CONTACT FOR A REFERENCE?
Yes   No   Later
REASON FOR LEAVING
HOURLY RATE/SALARY?
LICENSES/CERTIFICATIONS & SKILLS
LIST ANY SPECIAL TRAINING, SKILLS, LICENSES AND/OR CERTIFICATIONS THAT MAY QUALIFY YOU FOR THE POSITION FOR WHICH YOU ARE APPLYING:
LIST ALL OFFICE EQUIPMENT TO INCLUDE HARDWARE AND SOFTWARE YOU HAVE OPERATED:
REFERENCES
NAME (FIRST, LAST)
 OCCUPATION
 RELATIONSHIP
 TELEPHONE NO.
 NO. OF YEARS KNOWN
NAME (FIRST, LAST)
 OCCUPATION
 RELATIONSHIP
 TELEPHONE NO.
 NO. OF YEARS KNOWN
NAME (FIRST, LAST)
 OCCUPATION
 RELATIONSHIP
 TELEPHONE NO.
 NO. OF YEARS KNOWN
APPLICANT STATEMENT
I certify that all information I have provided in order to apply for and secure work with Country Fresh Products, LLC 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 (1) cancel further consideration of this application, or (2) immediately discharge me from the Company's service, whenever it is discovered.

I expressly authorize, Country Fresh Products, LLC, it's representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions, to verify the accuracy of all information provided by me in this Application for Employment, resume and/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 Country Fresh Products, LLC does not 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.

If I am hired, I understand that I am free to resign at any time with or without cause and without prior notice, and Country Fresh Products, LLC reserves the same right to terminate my employment at any time, with or without cause and without prior notice. 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 Company 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.

I 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 an 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 agree to the Application Statement, and all of the information provided by me to Country Fresh Products LLC, either in person or in writing above on this form is true and correct.

* Name of Applicant
 * Date