Employment with Liberty Ridge

Application

* indicates required fields

* First Name:

* Last Name:

* Soc. Sec.

* Phone:

* E-mail:

Fax:

* Street Address:

* City:

* State:

Zip:

Are you under the age of 18? *

(If under 18, hire is subject to verification of minimum legal age, Employment Certificates or Permits may be required)

Have you been convicted of a crime? *

If yes, please explain:

Are you a US Citizen? *

Do you have transportation to and from work? *

If hired, are you willing to submit to and pass a controlled substance test? *

Do you speak, write or understand any foreign Languages?

If yes, what languages?

How were you referred to Liberty Ridge Farm?

What date can you start? *

EDUCATION

Are you currently in school? *

If yes, Name/Location of School:

List any fall after school activities you are involved in:

EMPLOYMENT

Do you have any experiences, training, qualifications, or skills which you feel should be brought to our attention, in the case that they make you especially suited for a position? If yes, please explain:

PREVIOUS EMPLOYMENT
Start with your most recent employer:

EMPLOYER 1:
Start Date:

End Date:

Position:

Employer Name/Address/Phone:

EMPLOYER 2:
Start Date:

End Date:

Position:

Employer Name/Address/Phone:

EMPLOYER 3:
Start Date:

End Date:

Position:

Employer Name/Address/Phone:

REFERENCES:
Give the names of two persons not related to you whom you have known at least
one year. If you know someone who works at Liberty Ridge Farm, you may use their name.

Reference 1

Name:

Relationship:

Phone Number:

Years Acquainted:

Reference 2

Name:

Relationship:

Phone Number:

Years Acquainted:

AVAILABILITY:
From September 12 - November 2

Mondays:

Tuesdays:

Wednesdays:

Thursdays:

Fridays:

Saturdays:

Sundays:

School Activity Schedule or Other Special Notes:

IN CASE OF EMERGENCY, NOTIFY:
(Include name, phone, relationship)

Verify image:

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Enter text as shown in image above *

By sumbitting this form, I hereby certify that all the information above is true and complete. I understand that all information is subject to verification. I consent that you may contact references, former employers and educational institutions regarding this application. I also consent to criminal history background checks.

Dear #first_name#: Thank you for contacting Liberty Ridge Farm. Your application has been received. Liberty Ridge Farm 29 Bevis Road Schaghticoke, NY 12154 Phone: 518-664-1515 Fax: 518-664-5992 Dear Liberty Ridge Farm, You have received a new application from your website's Employment Form! * --------------------------------------------------------* * First Name: #first_name# * Last Name: #last_name# * Social Security: #social_security# * Phone: #phone# * Email Address: #email# * Fax: #fax# * Address: #address# * City: #city# * State: #state# * Zip Code: #zip# * Are you under 18: #under_18# * Have you been convicted of a crime? * If yes, please explain: * #crime_conviction# * #crime_explaination# * Are you a US Citizen? * #us_citizen# * Do you have transportation to and from work? * #transportation# * If hired, are you willing to submit to and pass a controlled substance test? * #substance_test# * Do you speak, write or understand any foreign Languages? * If yes, what languages? * #foreign_language# * #language_descrip# * How were you referred to Liberty Ridge Farm? * #referred# * What date can you start? * #start_date# * Are you currently in school? * #school# * If yes, Name/Location of School: * #school_descrip# * List any fall after school activities you are involved in: * #school_fall_activities# * EMPLOYMENT * Do you have any experiences, training, qualifications, or skills which you feel should be brought to our attention, in the case that they make you especially suited for a position? If yes, please explain: * #qualifications# * PREVIOUS EMPLOYMENT * EMPLOYER 1: * Start Date: #employer_1_start_date# * End Date: #employer_1_end_date# * Position: #employer_1_position# * Employer Name/Address/Phone: * #employer_1_name_address_phone# * EMPLOYER 2: * Start Date: #employer_2_start_date# * End Date: #employer_2_end_date# * Position: #employer_2_position# * Employer Name/Address/Phone: * #employer_2_name_address_phone# * EMPLOYER 3: * Start Date: #employer_3_start_date# * End Date: #employer_3_end_date# * Position: #employer_3_position# * Employer Name/Address/Phone: * #employer_3_name_address_phone# * REFERENCE 1 * Name: #reference_1_name# * Relationship: #reference_1_relationship# * Phone Number: #reference_1_phone# * Years Acquainted: #reference_1_years# * REFERENCE 2 * Name: #reference_2_name# * Relationship: #reference_2_relationship# * Phone Number: #reference_2_phone# * Years Acquainted: #reference_2_years# * AVAILABILITY: * From September 12 - November 2 * Mondays: #availability_mondays# * Tuesdays: #availability_tuesdays# * Wednesdays: #availability_wednesdays# * Thursdays: #availability_thursdays# * Fridays: #availability_fridays# * Saturdays: #availability_saturdays# * Sundays: #availability_sundays# * School Activity Schedule or Other Special Notes: * #special_notes# * IN CASE OF EMERGENCY, NOTIFY: * #ice_contact# Dear #first_name#: Thank you for contacting Liberty Ridge Farm. Your application has been received. Liberty Ridge Farm 29 Bevis Road Schaghticoke, NY 12154 Phone: 518-664-1515 Fax: 518-664-5992 Dear Liberty Ridge Farm, You have received a new application from your website's Employment Form! * --------------------------------------------------------* * First Name: #first_name# * Last Name: #last_name# * Social Security: #social_security# * Phone: #phone# * Email Address: #email# * Fax: #fax# * Address: #address# * City: #city# * State: #state# * Zip Code: #zip# * Are you under 18: #under_18# * Have you been convicted of a crime? * If yes, please explain: * #crime_conviction# * #crime_explaination# * Are you a US Citizen? * #us_citizen# * Do you have transportation to and from work? * #transportation# * If hired, are you willing to submit to and pass a controlled substance test? * #substance_test# * Do you speak, write or understand any foreign Languages? * If yes, what languages? * #foreign_language# * #language_descrip# * How were you referred to Liberty Ridge Farm? * #referred# * What date can you start? * #start_date# * Are you currently in school? * #school# * If yes, Name/Location of School: * #school_descrip# * List any fall after school activities you are involved in: * #school_fall_activities# * EMPLOYMENT * Do you have any experiences, training, qualifications, or skills which you feel should be brought to our attention, in the case that they make you especially suited for a position? If yes, please explain: * #qualifications# * PREVIOUS EMPLOYMENT * EMPLOYER 1: * Start Date: #employer_1_start_date# * End Date: #employer_1_end_date# * Position: #employer_1_position# * Employer Name/Address/Phone: * #employer_1_name_address_phone# * EMPLOYER 2: * Start Date: #employer_2_start_date# * End Date: #employer_2_end_date# * Position: #employer_2_position# * Employer Name/Address/Phone: * #employer_2_name_address_phone# * EMPLOYER 3: * Start Date: #employer_3_start_date# * End Date: #employer_3_end_date# * Position: #employer_3_position# * Employer Name/Address/Phone: * #employer_3_name_address_phone# * REFERENCE 1 * Name: #reference_1_name# * Relationship: #reference_1_relationship# * Phone Number: #reference_1_phone# * Years Acquainted: #reference_1_years# * REFERENCE 2 * Name: #reference_2_name# * Relationship: #reference_2_relationship# * Phone Number: #reference_2_phone# * Years Acquainted: #reference_2_years# * AVAILABILITY: * From September 12 - November 2 * Mondays: #availability_mondays# * Tuesdays: #availability_tuesdays# * Wednesdays: #availability_wednesdays# * Thursdays: #availability_thursdays# * Fridays: #availability_fridays# * Saturdays: #availability_saturdays# * Sundays: #availability_sundays# * School Activity Schedule or Other Special Notes: * #special_notes# * IN CASE OF EMERGENCY, NOTIFY: * #ice_contact#

29 Bevis Road Schaghticoke, NY 12154 | phone: 518-664-1515

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