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Date of Application *

First name *

Middle name

Last name *

Address

Phone number *

Email address *

EMPLOYMENT DESIRED

Position(s) Applying For *

Are you applying for? *

Regular Full Time Work

Regular Part Time Work

Are you available to work
on weekends? *

Yes

No

Would you be available to work
overtime, if necessary? *

Yes

No

If hired, what date can you start work? *

Are you able to perform the essential job functions of the job for which you are applying with or without reasonable accommodation? *

Yes

No

If no, describe the functions that cannot be performed.

EMPLOYMENT EXPERIENCE

List the names of your present or previous employers in chronological order with present or most recent employer listed first. Be sure to account for all periods of time. If self-employed, give firm name and supply business references. Add additional page if necessary.

Have you ever been involuntarily terminated or asked to resign from any job? *

Yes

No

If yes, explain:Explain any gaps in your employment history:List any other experience, job related skills, additional languages, or other qualifications that you believe should be considered in evaluating your qualifications for employment.

EDUCATION

Describe your educational background below

High School

School Name

Year Completed

Diploma/Degree?

Yes

No

Area of Study/Major

Specialized Training, Skills, or ExtraCurricular Activities

College/University

School Name

Year Completed

Diploma/Degree?

Yes

No

Area of Study/Major

Specialized Training, Skills, or ExtraCurricular Activities

Graduate/Professional School

School Name

Year Completed

Diploma/Degree?

Yes

No

Area of Study/Major

Specialized Training, Skills, or ExtraCurricular Activities

Trade School

School Name

Year Completed

Diploma/Degree?

Yes

No

Area of Study/Major

Specialized Training, Skills, or ExtraCurricular Activities

Other

School Name

Year Completed

Diploma/Degree?

Yes

No

Area of Study/Major

Specialized Training, Skills, or ExtraCurricular Activities

Name and Title *

Relationship *

Phone Number or Email *

Name *

Relationship and Years Acquainted *

Phone Number or
Email *

*

I hereby authorize Ninth Ave. Foods to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the prior employers and references I have listed to disclose to Ninth Ave. Foods all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release Ninth Ave. Foods, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure.

*

If I am employed by Ninth Ave. Foods, I understand that I am required to comply with all rules and regulations of the Ninth Ave. Foods

*

If hired, I understand and agree that my employment with Ninth Ave. Foods is at-will, and that neither I, nor the Ninth Ave. Foods is required to continue the employment relationship for any specific term. I further understand that the Ninth Ave. Foods or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications.

*

I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

*

I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration laws require me to complete an I-9 Form in this regard.

*

I understand that if any term, provision, or portion of this Agreement is declared void or unenforceable, it shall be severed and the remainder of this Agreement shall be enforceable.

Sign Your Full Name (Electronic Signature): *

Today's Date *

Employment Application

Quality Technician

EMPLOYMENT DESIRED

EMPLOYMENT EXPERIENCE

EDUCATION

High School

College/University

Graduate/Professional School

Trade School

Other

BUSINESS AND PROFESSIONAL REFERENCES

PERSONAL REFERENCES

GENERAL INFORMATION

APPLICANT STATEMENT AND AGREEMENT

MY SIGNATURE INDICATES THAT I HAVE READ, UNDERSTAND, AND AGREED TO ALL OF THE ABOVE TERMS