Employment Application

Name(Required)
Address(Required)
MM slash DD slash YYYY
Are you legally eligible for employment in the United States?(Required)
(If offered employment. you will be required to provide documentation to verify eligibility)

Education, Special Training & Skills

High School

High School(Required)
GED(Required)

College/Vocational School

Other Training/Degree(s)

Have you ever been convicted of a crime?(Required)

Previous Experience

Starting with the most recent, list all jobs held, within the last 10 years and the employers within that period (minimum of 3, if you have had 3). Include any relevent volunteer activities. Please explain any gaps in employment history.

May we contact this employer?
Employment Dates (Month/Year):
From
To
Employment Status

Reason for Leaving:

Were you ever terminated or discharged from this job?
Did you ever quit under threat of discharge?
May we contact this employer?
Employment Dates (Month/Year):
From
To
Employment Status

Reason for Leaving:

Were you ever terminated or discharged from this job?
Did you ever quit under threat of discharge?
May we contact this employer?
Employment Dates (Month/Year):
From
To
Employment Status

Reason for Leaving:

Were you ever terminated or discharged from this job?
Did you ever quit under threat of discharge?
Have you ever received any discipline in the workplace?
Professional References
Name:
Phone:
Relationship
Years Known:
 
Personal References
Name:
Phone:
Relationship
Years Known:
 

APPLICANT'S CERTIFICATION AND AGREEMENT

I hereby certify that the facts set forth in this employment application are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of relevant facts on this application (or any other documents) may result in me no longer being considered for employment, withdrawal of any offer of employment, or immediate termination of employment, regardless of when or how discovered. Withdrawal of any offer of employment or termination of employment under such conditions will be accomplished with no liability for Potandon Produce LLC ("Potandon"), its offers, directors, managers, employees, agents, and affiliates (together, "Agents and Affiliates"), or further obligation to me, other than for payment through the last day of employment for earnings from Potandon at the rate agreed upon.

I authorize investigation of all statements contained herein, including my employment history, educational records, a criminal background check, a driver history check, and similar background information, as Potandon deems relevant and necessary, and I release Potandon, its Agents and Affiliates, from any and all liability, claims, or damages that may result from conducting such an investigation, and promise not to sue potandon, its Agents and Affiliates, in connection with releasing such information, consistent with any limitations imposed by law. I authorize the references listed above to give you any and all information, consistent with any limitations imposed by law. I authorize the references listed above to give you any and all information concerning my previous employment, and release from liability any persons providing such information.

I understand that this an application for at-will employment and is not an offer of employment. I understand and agree that should an employment offer be extended to me and accepted that I will fully adhere to Potandon's policies, rules and regulations of employment. I understand that neither the policies, rules, regulations of employment nor anything said during the interview process shall be deemed to constitute the terms of an employment contract (express, implied, or otherwise). I understand that any employment offered within Potandon is purely at-will. As such, if I am employed by Potandon, either Potandon or I may terminate the employment relationship with or without cause or advance notice at any time.

I understand that should I be offered employment at Potandon, I will be subject to a pre-employment drug screening and that any potential future employment is contingent upon my continual compliance with the Alcohol and Drug Free Workplace Policy.

I have read and reviewed the information provided in this application and the above statements.

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