|
APPLICATION FOR EMPLOYMENT |
| 1. Today's date: ________________________ |
| 2. Name: _____________________________ |
3. Address ________________________________________________
Street
City,
State
Zipcode |
| 4. Telephone number: HOME (___) _______________ WORK
(___)______________ |
| 5. Social Security number:
_________________________________ |
| 6. How did you hear about Larriland?
_________________________ |
7. Work desired:
a. List the position for which you are applying:
___________________
b. Minimum hourly wage required: ______________
c: Date available for work:
_______________________ |
8. Qualifications: Describe your previous work experience,
knowledge, and skills that you feel qualify you for this work:
_________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________ |
9. Do you have any physical limitations that would hinder
or limit your capacity to perform farm work? YES ______ NO _______
If yes, please describe:
__________________________________________________
____________________________________________________________________ |
10. Education:
Name of
School
Course
Degree, Certificate
or Diploma earned
_____________________________________________________________________
_____________________________________________________________________ |
11. During the last seven years, have you been convicted of
a misdemeanor or of a felony or convicted in a military court martial? YES
_______ NO ________
If yes, state the dates and circumstances involved:
_______________________________
_____________________________________________________________________
_____________________________________________________________________ |
12. Employment History: List your last three employers
below:
Employer's name,
address
Employed
Salary
and
telephone
From -
To
Start - End
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Describe your duties: ___________________________________________________
____________________________________________________________________
____________________________________________________________________
Reasons for leaving: ____________________________________________________
____________________________________________________________________
____________________________________________________________________ |
13. Personal References: List 3 references (other than
immediate family members) with addresses and telephone numbers.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________ |
14. In case of emergency, notify:
Name (relationship to you) _________________________
Address _______________________________________
Telephone:
Work:
__________________________________
Home:
__________________________________
Cellular Phone: ____________________________ |
|
READ AND SIGN BELOW
The facts set forth in the Application for Employment are true and
complete. I understand that, if employed, false statements on this
application shall be considered sufficient cause for dismissal. The
Company is hereby authorized to make any investigation of my personal
history, employment references or history, and/or credit record through an
investigative or credit agency or bureau of your choice. I further agree
that, if hired, my employment is for a definite duration and either the
Company or I may terminate our relationship at will, without notice, and
with or without reason. Moreover, I understand that only the President of
the Company may enter into any agreement concerning the length of my
employment.
_______________________________________________
Signature
Date |
|
READ AND SIGN BELOW
UNDER MARYLAND LAW, AN EMPLOYER MAY OR MAY NOT REQUIRE OR DEMAND ANY
APPLICANT FOR EMPLOYMENT OR PROSPECTIVE EMPLOYMENT OR ANY EMPLOYEE TO
SUBMIT TO OR TO TAKE A POLYGRAPH, LIE DETECTOR OR SIMILAR TEST OR
EXAMINATION AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. ANY
EMPLOYER WHO VIOLATES THIS PROVISION IS GUILTY OF A MISDEMEANOR AND
SUBJECT TO A FINE NOT TO EXCEED $100.00.
_______________________________________________
Signature
Date
PAYROLL DEDUCTION AUTHORIZATION
I, _______________________________, AUTHORIZE MY EMPLOYER, LARRILAND
FARM, INC., HEREINAFTER REFERRED TO AS THE COMPANY, TO DEDUCT FROM MY NET
PAY, AFTER ALL OTHER LAWFUL DEDUCTIONS HAVE BEEN MADE: (1) THE MONETARY
AMOUNTS(S) OF ANY SHORTAGE(S) OF COMPANY MONIES ASSOCIATED WITH MY
EMPLOYMENT POSITION, AND/OR (2) THE MONETARY AMOUNT(S) OF ANY TRAFFIC
AND/OR PARKING FINES ASSESSED AGAINST THE COMPANY WITH RESPECT TO ANY
COMPANY VEHICLE IN MY POSSESSION, AND/OR (3) THE MONETARY AMOUNT(S) OF
DAMAGES TO A COMPANY VEHICLE CAUSED BY AN ACCIDENT(S) FOR WHICH I AM FOUND
TO BE AT FAULT. THESE DEDUCTIONS MAY BE TAKEN OUT OF MY WEEKLY PAYCHECKS
FROM THE COMPANY OR OUT OF MY FINAL PAYCHECK FROM THE COMPANY, AS
APPLICABLE.
_______________________________________________
Employee
Signature
Date
_______________________________________________
Witness
Signature
Date |
