Applicant Information

Last Name

First

M.I.

Date

Street Address

Apartment/Unit #

City

State

ZIP

Phone

E-mail Address

Date of Birth

Social Security No.

Desired Salary

Position Applied for

Are you a citizen of the United States?

YES

NO

If no, are you authorized to work in the U.S.?

YES

NO

How did you hear about Spring Meadow Farms?

Do you have any physical limitations that world hinder or limit your capacity to perform farm or farm market work?

YES

NO

If yes, explain

Have you ever been convicted of a felony?

YES

NO

If yes, explain

Date available to begin work:

Education

High School

Address

From

To

Did you graduate?

YES

NO

Degree

College

Address

From

To

Did you graduate?

YES

NO

Degree

Other

Address

From

To

Did you graduate?

YES

NO

Degree

References

Please list three professional references.

Full Name

Relationship

Company

Phone

( )

Address

Full Name

Relationship

Company

Phone

( )

Address

Previous Employment

Company

Phone

( )

Address

Supervisor

Job Title

Starting Salary

$

Ending Salary

$

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

YES

NO

Company

Phone

( )

Address

Supervisor

Job Title

Starting Salary

$

Ending Salary

$

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

YES

NO

Military Service

Branch

From

To

Rank at Discharge

Type of Discharge

If other than honorable, explain

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.

Signature

Date