Employment Application

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Personal Information

First Name:

Middle Initial:

Last Name:

Date:

Street Address:

Suite/Apt:

City:

State:

Zip code:

Phone Number:

Email Address:

Date Available:

Position Applying for:

Salary Expectation:

Store Preference:

Are you a citizen of the United States? Yes No

If no, are you authorized to work in U.S.? Yes No

Have you ever worked for Frazier Farms? Yes No

If yes, explain:

Education

Highschool:

Address:

Start Date:

End Date:

Did you graduate? Yes No

College:

Address:

Start Date:

End Date:

Did you graduate? Yes No

Degree:

Other Education:

Address:

Start Date:

End Date:

Did you graduate? Yes No

Degree:

References

Please list three professional references.

First Name:

Last Name:

Relationship:

Company:

Phone Number:

Address:

First Name:

Last Name:

Relationship:

Company:

Phone Number:

Address:

First Name:

Last Name:

Relationship:

Company:

Phone Number:

Address:

Previous Employment

Company:

Phone:

Address:

Supervisor:

Job Title:

Responsibilities:

Start Date:

End Date:

Reason for Leaving:

May we contact your previous supervisor for a reference? Yes No

Company:

Phone:

Address:

Supervisor:

Job Title:

Responsibilities:

Start Date:

End Date:

Reason for Leaving:

May we contact your previous supervisor for a reference? Yes No

Company:

Phone:

Address:

Supervisor:

Job Title:

Responsibilities:

Start Date:

End Date:

Reason for Leaving:

May we contact your previous supervisor for a reference? Yes No

Military Service

Branch:

Start Date:

End Date:

Are you a disabled veteran? Yes No

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature:

Date:

Employment Application

Personal Information

Education

References

Please list three professional references.

Previous Employment

Military Service

Disclaimer and Signature

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