Employment Application

All applicants are considered for all positions without regard to race, religion, color, sex, gender, sexual orientation, pregnancy, age, national origin, ancestry, physical or mental disability, medical condition, military or veteran status, genetic information, marital status, ethnicity, citizenship or immigration status or any other protected classification, in accordance with applicable federal, state, and local laws. By completing this application, you are seeking to join a team of hardworking professionals dedicated to consistently delivering outstanding service to our customers and contributing to the financial success of the organization, its clients, and its employees. Equal access to programs, services, and employment is available to all qualified persons. Those applicants requiring accommodation to complete the application and/or interview process should contact a management representative.

Date of Application *

Name *

First

Middle

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

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? *

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

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? *

If no, describe the functions that cannot be performed. Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for qualified applicants/employees to perform essential job functions.

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.

Name of Employer *

Supervisor *

May we contact? *

Street Address *

Phone Number *

Dates Employed (Month/Year) - From *

Dates Employed (Month/Year) - To *

Job Title and Duties *

Reason for Leaving *

Name of Employer

Supervisor

May we contact?

Street Address

Phone Number

Dates Employed (Month/Year) - From

Dates Employed (Month/Year) - To

Job Title and Duties

Reason for Leaving

Name of Employer

Supervisor

May we contact?

Street Address

Phone Number

Dates Employed (Month/Year) - From

Dates Employed (Month/Year) - To

Job Title and Duties

Reason for Leaving

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

List three professional references of individuals who are not related to you:

Name and Title *

Relationship *

Phone Number or Email *

Name and Title

Relationship

Phone Number or Email

Name and Title

Relationship

Phone Number or Email

PERSONAL REFERENCES

List three people who know you well:

Name *

Relationship and Years Acquainted *

Phone Number or Email *

Name

Relationship and Years Acquainted

Phone Number or Email

Name

Relationship and Years Acquainted

Phone Number or Email

GENERAL INFORMATION

If hired, would you have a reliable means of transportation to and from work? *

Are you at least 18 years old? *

Note: If under 18, hire is subject to verification that you are of minimum legal age

If hired, can you present evidence of your identity and legal right to work in this country? *

APPLICANT STATEMENT AND AGREEMENT

Read and initial each paragraph below. Then, select the check mark. If there is anything that you do not understand, please ask.

agreement *

Initial added *

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.

agreement *

Initial added *

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

agreement *

Initial added *

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.

agreement *

Initial added *

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.

agreement *

Initial added *

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.

agreement *

Initial added *

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.

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

Sign Your Full Name (Electronic Signature): *

Today's Date: *