Application for Employment

Application for Employment
Personal Information
Date:

Month Day Year
Date
Name *

First Name MI Last Name
Address *

Street Address

Street Address Line 2

City, State, Zip Code State / Province

Postal / Zip Code
Email: *
example@example.com
Phone Number: *
Mobile: *
Are you legally authorized to work in the United States? *

Yes No
NOTE: Federal law requires that you provide and that Stoltzfus Meats, Inc. examines documents which verify your identity and your eligibility for employment in the United States. As a condition of employment, you are required to provide such documentation as mandated by law or government regulation and to sign a form attesting that you are lawfully able to work in the United States.
How did you learn about Stoltzfus Meats? *
Referred by:
Are you over the age of 18 years? *

Yes No (If no, you may be required to provide authorization to work)
Stoltzfus Meats, Inc. is an Equal Opportunity Employer. Our personnel policy is aimed at assuring equal treatment to all individuals with regard to employment, rates of pay, and all other terms and conditions of employment, regardless of race, religion, color, national origin, sex, sexual orientation, age, veteran’s status or non-job related disability. Please complete this application omitting information that reflects these factors. The United States Age Discrimination in Employment Act of 1967 and the Pennsylvania Human Relations Law prohibit discrimination based on age with respect to individuals who are at least 40 years of age.
Employment Desired
Position: *
Date you can start: *

Month Day Year
Date
Salary desired:
Are you employed now? *

Yes No
If so, may we inquire of your present employer?

Yes No
Have you ever applied for a job at Stoltzfus Meats before? *

Yes No
If yes, when?
Do you have any relatives or friends who work at Stoltzfus Meats? *

Yes No
If so, who?
Are you available to work: *

Days Evenings Nights Weekends Full Time Part Time
Education

	Name & Location of School	Number of years attended	Diploma or Degree	Major Study
High School
College
Trade School

Former Employers

List your most recent employers, starting with your current employer.
Company Name (most recent/current employer)
Address

Street Address

Street Address Line 2

City, State, Zip Code
Phone Number
From (Month & Year)
To (Month & Year)
Supervisor
Job Title & Duties:
Reason for Leaving:
Company Name
Address

Street Address

Street Address Line 2

City, State, Zip Code
Phone Number
From (Month & Year)
To (Month & Year)
Supervisor
Job Title & Duties:
Reason for Leaving:
Company Name
Address

Street Address

Street Address Line 2

City, State, Zip Code
Phone Number
From (Month & Year)
To (Month & Year)
Supervisor
Job Title & Duties:
Reason for Leaving:
References

Give the names of three persons not related to you, whom you have known at least three (3) years.

	Name	Phone	Email Address	Occupation	Years Acquainted
#1
#2
#3

Military Branch
Branch:
Dates of Service:
Rank & principal duties:
Type of Discharge:
I hereby give Stoltzfus Meats, Inc. the right to make a thorough investigation into my previous employment, education, and references; and I release from all liability all persons, companies, and corporations supplying such information. I release, indemnify, and hold harmless Stoltzfus Meats, Inc. from and against any and all liability which might result from making such an investigation. I understand that any false answer, statement, or representation made by me in this application shall constitute sufficient cause for discharge. I also understand that nothing contained in the employment supplication or granting of an interview is intended to create an employment contract between Stoltzfus Meats, Inc. and myself for either employment or for the granting of benefits. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon Stoltzfus Meats, Inc. unless made in writing. If an employment relationship is established, I understand and agree that it is not for a definite period of time, and that I have the right to terminate my employment at any time, for any reason, or for no reason, and that Stoltzfus Meats, Inc. retains a similar right. I understand that, if accepted for employment, it is necessary to abide by the rules and policies of Stoltzfus Meats, Inc. and that I will be on a two (2) month probation before considered a regular employee.
Date: *

Month Day Year
Date
Signature: *

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Application for Employment

Personal Information

Employment Desired

Education

Former Employers

References

Military Branch