ALL POTENTIAL EMPLOYEES ARE EVALUATED WITHOUT REGARD TO RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, AGE, MARITAL OR VETERAN STATUS, THE PRESENCE OF A NON-JOB RELATED HANDICAP OR ANY OTHER LEGALLY PROTECTED STATUS.

An asterisk character * denotes required information.

Your Name * Date Submitted *
Address *

City* State* Zip*

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?*
YesNo

Can you lift a minumum of 20 pounds?
YesNo

Can you lift between 20 & 50 pounds?
YesNo

Can you lift over 50 pounds?
YesNo

How much can you lift, if none of the above apply?
pounds

Have you ever been involuntarily terminated or asked to resign from any position of employment?
YesNo
If yes, please describe circumstances:

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

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

Education

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

1.  Employer Job Title

Dates EmployedtoPrior Position Held within Company (if any):

AddressCityStateZip

PhoneJob TitleSupervisor

Starting SalaryEnding Salary

Duties Performed

Reason for Leaving

2.  Employer Job Title

Dates EmployedtoPrior Position Held within Company (if any):

AddressCityStateZip

PhoneJob TitleSupervisor

Starting SalaryEnding Salary

Duties Performed

Reason for Leaving

3.  Employer Job Title

Dates EmployedtoPrior Position Held within Company (if any):

AddressCityStateZip

PhoneJob TitleSupervisor

Starting SalaryEnding Salary

Duties Performed

Reason for Leaving

4.  Employer Job Title

Dates Employedto  Prior Position Held within Company (if any):

AddressCityStateZip

PhoneJob TitleSupervisor

Starting SalaryEnding Salary

Duties Performed

Reason for Leaving

ACKNOWLEDGMENT 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.

Signature of Applicant        Date