We are an Equal Opportunity Employer and consider applicants for all positions without regard to
race, color, religio, sex, national origin, age, disability, veteran or any other legally protected status

 

Applicant Information

Name  

Permanent Address

Street  

City         State     Zipcode

Phone       Cell

Summer Address (if different)

Street  

City         State     Zipcode

 
Email  

If Under 18, what is your date of birth?  

If 16 or younger, can you provide a work permit?       YesNo

Are you legally eligible to work in the United States? YesNo

Are you a veteran? YesNo

If yes, please give dates of service

Do you have any special skills/talents? YesNo
(i.e. singing, acting, instrument, etc.)

If yes, please describe  

Do you have a reliable means of transportation? YesNo

Have you ever been convicted of a crime?           YesNo
If yes, please explain

Education Information

Please mark the highest year completed 12345678

Name of school and location

GED 9101112

Name of school and location

College 1234

Name of college and location

Degree or Major                      

Employment Information

What days would you prefer to work?

SundayMondayTuesdayWednesdayThursdayFridaySaturday

List days you are not available to work

SundayMondayTuesdayWednesdayThursdayFridaySaturday

Until what date are you available to work?    

Please list any time off you are already aware of needing

Are you willing to work:

Overtime? YesNo

Weekends? YesNo

Holidays? YesNo

Are you currently employed?   YesNo

If hired, when would you be able to start?  

List any friends or relatives employed at Udder Heaven

Work History

Current or most recent employer

Name                  

Phone number  

Street address  

City/State/Zip    

Dates of employment:   From to

Salary:         Beginning   Ending

Job title              

Supervisor name & title

Briefly describe duties

Specific reason for leaving

Second employer

Name                  

Phone number  

Street address  

City/State/Zip    

Dates of employment:   From to

Salary:                

Job title              

Supervisor name & title

Briefly describe duties

Specific reason for leaving

May we contact these employers? YesNo

Have you ever been discharged or asked to resign from a position? YesNo

If yes, please describe

References

Please list three people we may contact who are not related to you, and whom you have known at least one year.
Include name, address and telephone

1

2

3

Authorization

I certify that the facts contained in this application are true and complete to the best of my knowledge and I understand that, if employed, falsified statements on this application shall be grounds for dismissal. I also understand that if hired, I will be expected to follow the procedures as identified in the employee manual.
I authorize the further confirmation of my statements and the contact of references and employers listed above for information pertinent to my previous and potential employment. I release the company from liability for any damage that may result from obtaining such information.

This authorization does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) or any other relevant federal and state law(s).
I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

Signature Date

Submit Application