Application For Employment Personal Information

Spanish Fork Name: Address: (Street)

Application For Employment

Available to Work at:

Orem

American Fork

Sandy

Riverdale

Date:

(City, State, Zip)

Position Applied For:

Phone Number:

Email Address:

Personal Information

Have you filed an application here before Yes, date________ No Interviewed? Yes No

Please list any other names you have worked under:

Are you over 18? Yes No

What kind of employment are you looking for? Are you willing to work weekends?

Full Time Part Time

Yes No

Holidays? Yes No

Date available for work______/______/______ Desired salary range? ____________________________

If hired how long do you plan on being employed with Good Earth? ______________________________ Are you currently employed? _____________________________________________________________ Have you been convicted of a felony in the past 10 years? ______________________________________ Do any of your friends or relatives work here? List name & relationship:___________________________ Hours Available Monday: Tuesday: Wednesday: Thursday: Friday: Saturday:

High School: College:

Name:

Education

Major:

References

Email:

Last Year Completed: Last Year Completed:

Phone Number:

Name:

Email:

Phone Number:

Name:

Email:

Phone Number:

Employment History

Please list three most recent jobs (start with most recent or current job) Applications must be filled out completely even if a resume has been provided

1. Company:________________________ Position(s):__________________________________________

Dates: From____________ to _____________ Supervisor:__________________________________ City:_________________________State:__________________Phone:____________________________ Starting Pay: ___________ Ending Pay: _______________ May we contact? Yes No Reason for Leaving: Resigned with Notice Resigned without Notice Terminated Open for re-hire: Yes No Comments/ Reason for Leaving:__________________________________________________________

2. Company:________________________ Position(s):__________________________________________

Dates: From_____________ to _____________ Supervisor:__________________________________ City:_________________________State:__________________Phone:____________________________ Starting Pay: ___________ Ending Pay: _______________ May we contact? Yes No Reason for Leaving: Resigned with Notice Resigned without Notice Terminated Open for re-hire: Yes No Comments/Reason for Leaving ___________________________________________________________

3. Company:________________________ Position(s):__________________________________________

Dates: From_____________ to _____________ Supervisor:__________________________________ City:_________________________State:__________________Phone:____________________________ Starting Pay: ___________ Ending Pay: _______________ May we contact? Yes No Reason for Leaving: Resigned with Notice Resigned without Notice Terminated Open for re-hire: Yes No Comments/ Reason for Leaving ___________________________________________________________

Questions

Explain what characteristics you have that would help you to be successful at this job?

Do you have a background or experience working with natural foods or nutritional supplements?

I certify that answers given herein are true and complete. I authorize investigation of all statements contained in this application. In the event of employment, I understand that false or misleading information given in my application or interview may result in discharge.

Applicant Signature:____________________________________________________Date:_____________________

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