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Name:
Address:
Home Telephone number:
Work Telephone number:
Date of Birth:
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How did you here about Spring Meadow Farms:
Minimum hourly wage required:
Date available for work:
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Describe your previous work experience, knowledge, and skills that you feel qualify for this work:
Do you have any physical limitations that would hinder or limit your capacity to perform farm or farm market
work
NO
YES, see below
If yes, please describe.
Education:
High School:
Years Completed:
1
2
3
4
College:
Years completed
1
2
3
4
4+
Employment History: List you last three employers below:
Last or Current Employer's Name and Address:
Describe your duties:
Reasons for Leavening:
Employer's Name and Address
Describe your duties:
Reasons for Leavening:
Employer's Name and Address
Describe your duties:
Reasons for Leavening:
Personal References:
List 3 references (other than immediate family members)
Reference 1:
Reference 1 Phone number:
Reference 2:
Reference 2: Phone number:
Reference 3:
Reference 3: Phone number:
In case of emergency, notify:
Name:
Address
Telephone
Work:
Telephone Home:
Mobil:
READ AND SIGN BELOWAgreed
PAYROLL DEDUCTION AUTHORIZATION
I,
Agreed
