Schoharie Valley Farms The Carrot Barn

Employment Application

Applicant Information
Last Name
First
M.I.	Date
Street Address
Apartment/Unit #
City
State
ZIP
Phone
E-mail Address
Date Available
Hrs. per week requested
Desired Salary
Position Applied for	Greenhouse Field Store Bakery/Cafe Kitchen Flexible
Are you a citizen of the United States?	YES	NO	If no, are you authorized to work in the U.S.?	YES	NO
Have you ever worked for this company?	YES	NO	If so, when?
Have you ever been convicted of a felony?	YES	NO	If yes, explain
What interested you in applying?
Age ___ 14-15 ___16-18 ___over 18 ___ if under 16 do you have working papers?
Availability Sunday Monday Tuesday Wednesday Thursday Friday Saturday
To
From
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 two 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
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

Sue

2011-02-12

Microsoft Corporation