Date ______Name ______

Address ______

StreetCityStateZip Code

Home Phone ______Cell Phone ______Email ______

Are you legally eligible to be employed in the United States? ______Yes______No

Are you at least 16 years or older? ____ Yes ____ No Are you at least 21 years or older? _____ Yes _____ No

Have you ever worked for Cabarrus Brewing Co before?______Yes______No

Do you have any friends or relatives who work for Cabarrus Brewing Company? _____ Yes _____ No

If yes, who? ______

Position Applied For ______Date Available To Start ______

Can you perform the essential functions of the position for which you are applying, with or without a

reasonable accommodation? ______Yes ______No If you have questions about or are unsure of the

essential functions of the position you are applying for, please inquire before answering this question.

Are you available to work days? [ ] nights? [ ] weekends? [ ] holidays? [ ] Desired Pay Range ______

Indicate the hours you are available to work each day.

Sunday / Monday / Tuesday / Wednesday / Thursday / Friday / Saturday

Education

Name and Location Course of Study # of Years Attended Diploma/Degree

High School
College
Vocational or Trade School
Graduate School

Please list any academic honors, extracurricular activities, and/or offices held in high school or college; professional memberships or licenses; volunteer work; courses, seminars and/or special skills and training related to the position for which you are applying. (Do not include any information that may reveal your race, color, religion, sex, national origin, age, disability status or genetic information.)

Employment History

Please include your last seven (7) years of employment history, including periods of unemployment, beginning with your most recent employer.

Company Name Dates of Position/ Immediate Reason For

And Phone Number EmploymentJob Title Supervisor’s Name Leaving

If you are currently employed, may we contact your current employer? ______Yes ______No

If any employment was under a different name, please indicate the name ______

Have you ever been fired from a job or asked to resign by an employer? ______Yes ______No

References

Please provide three (3) references. These individuals should not be past supervisors or relatives.

Name ______Phone Number ______

Relationship ______Number of Years Known ______

Name ______Phone Number ______

Relationship ______Number of Years Known ______

Name ______Phone Number ______

Relationship ______Number of Years Known ______

Applicant’s Certification And Agreement

I certify that I have given Cabarrus Brewing Company true and complete information on this application. No requested information has been concealed or omitted. I authorize Cabarrus Brewing Company to verify the accuracy of the information and to obtain reference information regarding my work history and performance.

If any information provided is untrue or if I have concealed information, I understand that this will result in denial of employment and, if hired, may result in immediate termination.

I certify that if hired I will adhere to the policies, procedures, rules and regulations of Cabarrus Brewing Company.

I understand that if hired, my employment is for no definite time period and that either Cabarrus Brewing Company or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I also understand that no representative of Cabarrus Brewing Company has the authority to make assurances to the contrary.

______

Signature Date