| What position will you be applying for: |
| * First Name: |
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| * Last Name: |
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| * Soc. Sec. |
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| * Phone: |
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| * E-mail: |
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| Fax: |
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| * Street Address: |
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| * City: |
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| * State: |
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Zip: |
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If yes, please explain:
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Are you a US Citizen? *
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Do you have transportation to and from work? *
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If hired, are you willing to submit to and pass a controlled substance test? *
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Do you speak, write or understand any foreign Languages?
If yes, what languages?
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How were you referred to Liberty Ridge Farm?
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What date can you start? *
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EDUCATION
Are you currently in school? *
If yes, Name/Location of School:
List any fall after school activities you are involved in:
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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:
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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:
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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.
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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)
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