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Name*

First Middle Initial Last

Other Names Used In Education/Employment

First Last

Current Address*

Street Address Address Line 2 City State ZIP Code

Email*

Home Phone*

Cell Phone*

Applying to a specific job posting, are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?*

Yes
No

Have you ever been terminated from employment or asked to resign by an employer?*

Yes
No

If yes, please provide company names and details

Date Available for Employment

How did you hear about us?

Salary Desired*

Position Desired*

EMPLOYMENT ELIGIBLITY

Any offer of employment is also conditioned upon the successful completion of a background check. The Immigration Reform and Control Act of 1986 prohibit the employment of unauthorized aliens and require employers to verify the employment eligibility of all new employees. An offer of employment made by the Company will be conditioned upon you providing the documentation required by law as evidence of your personal identity and your authorization to work in the United States.

Are you at least 18 years or older*

Yes
No

(If no, you may be required to provide authorization to work).

Are You Legally Authorized to Work in the United States?*

Yes
No

EDUCATION & TRAINING

Full School Name - Do not abbreviate

Highschool or Prepatory

School Name	City	State	Major Course of Study	Did you graduate (yes/no)	Degree	GPA

Trade School/Technical School

School Name	City	State	Major Course of Study	Did you graduate (yes/no)	Degree	GPA

College

School Name	City	State	Major Course of Study	Did you graduate (yes/no)	Degree	GPA

Graduate School/Advanced Degree

School Name	City	State	Major Course of Study	Did you graduate (yes/no)	Degree	GPA

Employment

Have you ever worked for Vermont Packinghouse before?*

Yes
No

When did you work for Vermont Packinghouse?

Do you know anyone who works for our company?*

Yes
No

Who do you know that works at Vermont Packinghouse?

Previous Employer

Starting with your current or most recent employment, list all previous employers. Include self- employment, military service, and part-time jobs for at least the last four employers, if applicable. Must be completed in full for each employer. (add lines as needed using the "+" icon).

Company Name:	Street Address:	City, Zip:	State:	Phone Number:	Start Date:	End Date:	Position and Duties:	Reason for Leaving:	Name and Title of Manager:

Additional Information

State any additional information you feel may be helpful to us in considering your application. This could include any specialized training or courses you have completed that will aide in evaluating your qualifications for the position you are seeking.

References

Please list at least three people we may contact with reference to your application who can supply information pertaining to your job performance. Please do not use relatives. Add additional references by using the "+" icon.

Reference Name	Relationship To You	Title	Phone Number/Email	Years Acquainted

Attach a Resume (Word doc preferred)

AUTHORIZATION

I understand that the employer follows an “employment at will�? policy, in that the employer or I may terminate my employment at any time, or for any reason consistent with applicable state or federal law. I understand that this application is not a contract of employment. I understand that to be employed, I must be lawfully authorized to work in the United States and must show the employer documents to provethis.I understand that the company will investigate my work and personal history and verify all the data given on this application, on related papers and in the interviews. I authorize all individuals, schools, and firms named therein, except my current employer if so noted, to provide any information about me, and release them from all liability for damage in providing this information.

Applicant’s Signature*

* I certify that all the statements herein are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal of employment. By entering my name in this signature field it is the same as a physical signature of authorization.

Date

EMPLOYMENT ELIGIBLITY

EDUCATION & TRAINING

Employment

AUTHORIZATION

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