Work for us

Items marked with an asterisk (*) are required

If you have problems completing or submitting this form, please email info@marksburyfarm.com.

Your Name *

Address *

City * , State * Zip code *

Phone *

Cell phone

Your Email *

Salary desired (required-based on skill and ability to perform work) $

Hours available to work

Hours/days you absolutely can NOT work.

Availability ---Full-timePart-timeSeasonalSummer

Positions applied for (check all that apply)
 Meat cutter Labeling technician Sanitation specialist Prep/Sous chef Cashier/stocker

When available to begin work

Have you had any accidents in the past three years?  yes no If yes, how many?

Have you had any moving violations in the past 3 years?  yes no If yes, how many?

Driver's license number

State of issue

If hired, do you have transportation to work?  yes no

Work history

(list up to three previous jobs)

Previous job 1

Name of Employer

Dates of employment (From mm/yy to mm/yy)

Employer address

Employer phone

Name of last supervisor

Salary $

List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company

May we contact your employer  yes no

Name of Employer

Dates of employment (From mm/yy to mm/yy)

Employer address

Employer phone

Name of last supervisor

Salary $

List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company

May we contact your employer  yes no

Name of Employer

Dates of employment (From mm/yy to mm/yy)

Employer address

Employer phone

Name of last supervisor

Salary $

List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company

May we contact your employer  yes no

Skills

Typing

Computer  PC Macintosh Both

Applications (list)

List other skills

References

Please list two references other than relatives or previous employers

Reference 1

Name

Position

Company

Telephone

Reference 2

Name

Position

Company

Telephone

Have you ever been convicted of a misdemeanor or felony?  yes no

If yes, please describe the misdemeanor(s) or felony(s) - state nature of the crime(s), when and where convicted and disposition of the case

Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)

Are you 18 years or age or older?  yes no
If under 18, hire is subject to verification of minimum legal age

If hired, would you be able to present evidence of your US citizenship or proof of your legal right to work in the United States?

 yes no

If hired, are you willing to submit to and pass a controlled substance test?  yes no

Are you able to perform the essential functions of the job for which you are applying either with/without reasonable accommodation?  yes no

If no, describe the functions which cannot be performed

Note: Company complies with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skills/agility and may be subject to a medical examination conducted by a medical professional.

I CERTIFY THAT INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND COMPLETE. i UNDERSTAND THAT FALSE INFORMATION MAY BE GROUNDS FOR NOT HIRING ME OR FOR IMMEDIATE TERMINATION OF EMPLOYMENT AT ANY POINT IN THE FUTURE IF i AM HIRED. I AUTHORIZE THE VERIFICATION OF ANY OR ALL INFORMATION LISTED ABOVE.

 yes no