Employment Application

Your Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone *

Other Phone

Your Email *

Date of Birth *

Social Security Number

Position Sought *

How did you learn about the position?

On what date would you be available for work?

Desired Wage/Salary

Are you a U.S. citizen, or are you otherwise authorized to work in the U.S. without any restriction? *

Yes
No

Can you lift a minimum of 20 pounds?

Yes
No

Can you lift between 20 & 50 pounds?

Yes
No

Can you lift over 50 pounds?

Yes
No

How much can you lift, if non of the above apply? (in pounds)

Have you ever been involuntarily terminated or asked to resign from any position of employment?

Yes
No

If Yes, please describe the circumstance(s):

If selected for employment, are you willing to submit to a drug screening test at any time during your employment?

Yes
No

If selected for employment, do you give Chae Organics permission to run a background check?

Yes
No

Education

Layout

School Name

Location

Years Attended

Diploma/Degree Received

Other training, certifications, or licenses held:

List other information pertinent to the employment you are seeking:

REFERENCES (at least 1 business and 1 personal character reference):

Previous Employment

Employer 1

1. Employer Name

Supervisor Job Title

Your Job Title

Employer City/State/Zip Code

Supervisor Phone

Position Held (if any)

Employer Phone

Start Date of Employment

Starting Salary

Supervisor Name

End Date of Employment

Ending Salary

Employer 1 cont.

Duties Performed

Reason for Leaving

Employer 2

2. Employer Name

Supervisor Job Title

Your Job Title

Employer City/State/Zip Code

Supervisor Phone

Position Held (if any)

Employer Phone

Start Date of Employment

Starting Salary

Supervisor Name

End Date of Employment

Ending Salary

Employer 2 cont.

Duties Performed

Reason for Leaving

Employer 3

3. Employer Name

Supervisor Job Title

Your Job Title

Employer City/State/Zip Code

Supervisor Phone

Position Held (if any)

Employer Phone

Start Date of Employment

Starting Salary

Supervisor Name

End Date of Employment

Ending Salary

Employer 3 cont.

Duties Performed (copy)

Reason for Leaving (copy)

Employer 4

4. Employer Name

Supervisor Job Title

Your Job Title

Employer City/State/Zip Code

Supervisor Phone

Position Held (if any)

Employer Phone

Start Date of Employment

Starting Salary

Supervisor Name

End Date of Employment

Ending Salary

Employer 4 cont.

Duties Performed

Reason for Leaving

ACKNOWLEDGEMENT AND AUTHORIZATION

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

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause.

It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application
or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

Layout

Signature of Applicant *

Today's Date *

Employment Application

Education

Previous Employment

ACKNOWLEDGEMENT AND AUTHORIZATION

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