All qualified applicants will be considered for employment without discrimination based on race, creed, gender, age, marital status, national origin, disability or veteran status.

P
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S
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N
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L / Last Name First Middle / Date of this application
Street Address / Home Phone
City, State, ZIP / Cell Phone
Have you ever applied for employment with us?
___ Yes ___ No If Yes, month and year______/ How long at present address?
Position you are applying for: / Wage/Salary Desired
___ Full-time ____ Part-time ____ Weekends only
How many hours per week are you available? _____ / Are you 18 years or older? ____Yes ____No
Are you involved in any pending criminal charge allegations? _____Yes _____No
Have you been convicted of a crime in the past ten years, excluding misdemeanors and summary offenses, which has not been annulled, expunged, or sealed by the court? _____ Yes _____ No If “Yes”, describe in full.
Answering yes to either of these questions does not automatically disqualify your application.
List the names of relatives and friends working for us.
Why do you want to work for us? What interested you in working for the Elegant Farmer?
When will you be available to begin work? / Are you legally eligible for employment in the United States? _____ Yes _____ No
Are there any job duties that you would be unable to perform? / Do you have transportation to and from work?
_____ Yes _____ No
EDUCATION / Type of School / Name & location of School / Course of Study / Number of years completed / Did you Graduate? / Degree, Certificate, License, or Diploma
High School
College
Other
Other special training or skills (languages, machine operation, administrative, etc.)

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EMPLOYMENT HISTORY

/ Please give accurate, complete full-time and part-time employment record. Start with your present or most recent employer.
1 / Company Name / Phone ( )
Address / Dates Employed – (give month and year)
From To
Name of Supervisor / Starting Pay
Ending Pay
Your Job Title and the type of duties you performed / Reason for Leaving
May we contact? ____Yes ____No
2 / Company Name / Phone ( )
Address / Dates Employed – (give month and year)
From To
Name of Supervisor / Starting Pay
Ending Pay
Your Job Title and the type of duties you performed / Reason for Leaving
May we contact? ____Yes ____No
3 / Company Name / Phone ( )
Address / Dates Employed – (give month and year)
From To
Name of Supervisor / Starting Pay
Ending Pay
Your Job Title and the type of duties you performed / Reason for Leaving
May we contact? ____Yes ____No

W O R K A V A I L I A B I L I T Y – List the times that you are available to work each day.

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
FROM
TO
SIGNATURE /
PLEASE READ BEFORE SIGNING
I understand that, if employed, employment is at will, and may be terminated by the employer or employee at any time for any reason, with or without cause, and with or without notice. I authorize the Elegant Farmer, Inc. to perform any necessary reference and background checks, and agree to indemnify and hold harmless The Elegant Farmer, Inc., any former employers, and all parties providing information relevant to my employment history. I certify that the information on this application is true, correct, and complete, and understand that failure to answer any questions truthfully, giving false or misleading information, and/or failing to disclose relevant information may be grounds for refusal of employment or, if employed, immediate termination of employment. I agree to a drug test if considered for employment.
Date______Signature______