Homeland Creamery Employment Application

First Name

Last Name

Present Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Phone

D.O.B.

Are you under age 18

Are you currently authorized to work in the United States?

*Proof of eligibility will be required if hired.

If yes, can you provide proof of your eligibilty to work?

Position Applied for:

Are you able to perform the duties of the position applied for with or without a reasonable accomidation?

Employment desired:

FULL-TIME ONLY
PART-TIME ONLY
TEMPORARY/CONTRACT

When are you able to start work?

Have you ever worked for another company under a different name?

Education

High School, Name Location

Number of years completed

College, Name

Number of years completed/Degree

Bus. or Trade school, Name

Number of years completed/Degree

Professional School Name

Number of years completed/Degree

Work Exerience

Please list your work experience for the beginning with your most recent job held.
If you were self-employed, give firm name. Attach additional sheets if necessary.

Name of Employer

Name of last supervisor:

Employment Dates

Job Title

Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Reason for leaving be specific:

Name of Employer

Name of last supervisor:

Employment Dates

Job Title

Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Reason for leaving be specific:

Name of Employer

Name of last supervisor:

Employment Dates

Job Title

Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Reason for leaving be specific:

Name of Employer

Name of last supervisor:

Employment Dates

Job Title

Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Reason for leaving be specific:

May we contact your present employer?

How would you describe your personality?

Tell us about yourself (clubs, hobbies, etc.)

Have you ever been in the armed forces?

Have you ever been convicted of a felony?

A conviction record will notnecessarily disqualify you from employment.

Are you now a member in the armed forces?

Checkbox Description

Specialty

Date Entered

Discharge Date

Didyou complete this application yourself?

If not, who did?

PLEASE READ CAREFULLY

After reviewing the attached job description, please indicate if you are able to perform the essential functions of the job for which you have applied, with or without a reasonable accomodation?

I hereby authorize the potential employer to contact, obtain, and verify the accuracy of the information contained in the application from all previous employers, educational institutions and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancelation of this application or immediate termination of employment if I am employed, whenever it may be discovered.

If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

We are an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age height, weight, or disability. We assure you that your opportunity for employment with us depends solely on your qualifications.

Thank you for completing this application form and for your interest in our business.

Applicant Signature

Today's Date

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Homeland Creamery Employment Application

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