Lovely's Farm Market Employment Form

Today's Date

Date

Name:*

First NameMiddle InitialLast Name

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

E-mail Address:*

Are you legally allowed and eligible to workin the United States?*

YesNo

The position you are applying for is: produce or deli. What is your expected salary per hour?*

/ per hour

Type of Employment*

Full-TimePart-Time

Will you accept part-time employment?*

YesNo

If yes, please specify the days and hours you are available to work?

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
AM
PM

If your application is considered favorably, what date can you start work*

Date

What is your current age?*

15-1718 or over

We are a seasonal business, beginning the first of May through the end of October, can you work this period of time continually?*

YesNo

If you answered no, what is the latest date you can work?

Please list all dates and times you already know you will need to be off during your employment between May-October (i.e. vacation, special events, sports, etc.) We like to allow for only 1 week vacation time requested off, we have limited amount of employees and we must be able to schedule accordingly. Please be specific.

If in college what would be your last day of employment?

Date

Please list any specific skills or abilities related to the job applied for.

Why would you like to work at Lovely's Farm Market?*

	Name & Occupation	E-Mail	Telephone Number
First Reference
Second Reference
3rd Reference

Please indicate last level of education completed*

Education Information *

	Name and Location (city and state)	# of Years Attended	Degree	Major
High School
College of University
Technical or Secondary school
Additional line if needed

If you are currently employed, may we contact your employer?*

YesNo

Name/Address of Most Recent Employer*

Name of Employer

Phone Number*

Area CodePhone Number

Describe the work you did*

Start and End Dates of Employment*

Month/Year

Salary/hour*

Exact Reason for Leaving*

Name/Address of 2nd Employer*

Name of Employer

Phone Number*

Area CodePhone Number

Describe the work you did*

Start and End Dates of Employment*

Month/Year

Salary/hour*

Exact Reason for Leaving*

Have you been convicted of a felony or misdemeanor in the past 7 years--other than a minor traffic offence--which has not been pardoned or expunged from your record?*

YesNo

If yes, please list date, city, charge and disposition.

THANK YOU FOR YOUR INTEREST IN EMPLOYMENT AT LOVELY'S FARM MARKET.

This application will become inactive after 60 days. If you wish to be considered for employment after that time, you must complete a new application for employment. All applications will, however, be retained in our files for a period of twelve months. It is the policy and practice of Lovely’s Farm Market to provide all qualified employees and applicants for employment with equal employment opportunities without regard to age, race, religion, color, sex, pregnancy, ancestry, national origin, disability or any other status or condition protected by applicable law. However, we insist that all of our employees can perform the essential functions of their employment and have the character, integrity and general reputation for honesty of a person we would be willing to have to represent our Company in its dealings with customers, suppliers and/or other employees. Accordingly, we insist on complete honesty. ANY LATER DISCOVERY THAT AN APPLICANT WAS NOT HONEST IN COMPLETING THIS APPLICATION MAY RESULT IN DISCHARGE.

AFFIDAVIT:

By signing below, you authorize or instruct this Company to make whatever inquiries it deems necessary (any former employer, personal reference or school official named in this application or referred by a person named in this application and of any law enforcement agency) in order to verify any information given in your application and/or determine your qualifications and abilities and you agree to release and hold harmless all such persons from any and all liability arising from the release of such information. You understand that such inquiries may include information as to your character, general reputation or personal characteristics.

You attest that the statements you made or information you provided in the application are true and complete. You understand that if, in the judgement of the Company, you have made any false statements, omissions, concealment any misrepresentations or you have failed to answer any questions fully and accurately or results of such investigation are not satisfactory, any offer made by the Company may be withdrawn or your employment with the Company may be terminated immediately, without any obligation to us other than for payment at the rate agreed upon for services rendered after you have been employed. You agree to conform to the rules and regulations of the Company and understand that if you are hired, your employment and compensation can be terminated without cause or notice at any time at the option of either the Company or yourself.

Authorization Signature of Applicant*

Parental Signature Required if applicant is under 18 years of age.

Please verify that you are human*

EMPLOYMENT APPLICATION

APPLICANT INFORMATION

PERSONAL REFERENCES

EDUCATION

Employment History

SECURITY INFORMATION

PLEASE READ BEFORE SIGNING