Employment Information Position Applied For (required) Date Available (required) First Name (required) Last Name (required) Middle Initial (required) Email (required) Social Security Number (required) Address (required) Apt # City (required) State (required) Zip (required) Home Telephone Number (required) Business Telephone Number Are you over the age of 18? Yes No If under 18, please state your date of birth. Are you eligible for employment in the United States? Yes No If yes, list restrictions. NOTE: If hired, you are required by law to submit proof of identity and eligibility to work in the U.S. Have you ever been employed here before? Yes No If yes, list dates and positions(s) Do you have any friends/relatives employed here? Yes No If yes, list name(s)/relationship(s) Are you capable of performing the essential functions of the job for which you are applying with reasonable accommodation? Yes No If no, please describe. Have you ever been convicted of a felony? Yes No If yes, please describe in detail. Note: Disclosure of a criminal record will not necessarily disqualify you from employment, as the nature of the offense, date and the position for which you are applying for will also be considered. Military Service Data Have you ever served in the U.S. Armed Forces? Yes No If yes, please give details/dates of services. List special skills/abilities acquired. Education Data Highest level of education completed High School College/University Graduate School Other If other, please provide details. Name of school attended (required) Address of school attended (required) City (required) State (required) Zip (required) Date you began attending school (required) Date you stopped attending school (required) Type of degree/diploma received or expected (required) Major/Minor fields of study List any honors or scholarships received List professional, trade, business or civic activities and offices held (you may exclude memberships which would reveal sex, race, religion, national origin, age, disability or other protected status) References List (with address and phone number) the names of three persons familiar with your character, ability or education for more than one year. Please do not include friends or relatives. Reference 1 (required) Reference 2 (required) Reference 3 (required) Employment Record 1 (Required) Please list date of all employment starting with your most recent position. Attach a separate sheet if necessary. Company Name (required) Company Address (required) City (required) Zip (required) Position/Title/Duties (required) Supervisor's Name/Title/Telephone Number (required) Starting date of employment (required) Ending date of employment (required) Starting Salary (required) Ending Salary (required) Reason for leaving (required) Employment Record 2 Please list date of all employment starting with your most recent position. Attach a separate sheet if necessary. Company Name Company Address City Zip Position/Title/Duties Supervisor's Name/Title/Telephone Number Starting date of employment Ending date of employment Starting Salary Ending Salary Reason for leaving Employment Record 3 Please list date of all employment starting with your most recent position. Attach a separate sheet if necessary. Company Name Company Address City Zip Position/Title/Duties Supervisor's Name/Title/Telephone Number Starting date of employment Ending date of employment Starting Salary Ending Salary Reason for leaving Applicant's Acknowledgement Permission is granted to Hancock Farms, Inc. to conduct an investigation and to solicit information as to my educational and employment history, character and general reputation, and criminal conviction record. I release Hancock Farms, Inc. and all persons or organizations from any liability arising from such statements, their solicitation or use. I understand that this employment application and any other company documents are not contracts of employment and that any individual who is hired may voluntarily leave or be terminated at any time, with or without cause. If terminated, I authorize Hancock Farms, Inc., to deduct, to the extent permitted by law, any amount which I may owe to Hancock Farms, Inc., from any amount which Hancock Farms, Inc. may owe me. I understand that no representative of Hancock Farms, Inc., has any authority to offer or to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing. I certify that all statements made by me on this application are true and correct to the best of my knowledge and belief. I understand that any false, inaccurate, or omitted statements of material fact could be cause for rejection of my application or termination of my employment at any time. I have read, understand, and consent to these statements.