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MAPLE LAWN WINERY, LLC

Employment Application

Applicant Information

Last Name

First

M.I.

Date

Street Address

Apartment/Unit #

City

State

ZIP

Phone

E-mail Address

Date Available

Social Security No.

Date of Birth

Are You 18?

YES  

NO  

If not, what is your age?

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

How will you get to work?

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 three personal references.

Full Name

Relationship

Address (if known)

Phone

Address

Full Name

Relationship

Address (if known)

Phone

Address

Full Name

Relationship

Address (if known)

Phone

Address


Previous Employment – Professional References (if none, please write n/a)

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  

PLEASE READ CAREFULLY – DISCLAIMER AND SIGNATURE

I authorize investigation of all statements contained in this application.  I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice.  I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract.

I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy.  I further understand that continued employment may be based on the successful passing of job-related physical examinations.

Signature

Date

This Company is an equal employment opportunity employer.  We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability.  We assure you that your opportunity for employment with this Company depends solely on your qualifications.  

Thank you for completing this application form and for your interest in our business.