Application for Employment

Pete and Gerry’s Organics is an equal opportunity employer and does not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state or federal law. Equal access to employment, services, and programs is available to all persons. Those applicants requiring reasonable accommodations to the application and /or interview process should notify a representative of the organization.

Personal Information

Full Name

Mailing Address

Telephone #

Are you over 18 years of age?

Email Address

Were you referred by an employee? If so, list name:

Date available for work

Salary required
per

Do you currently own or care for any birds of any kind?

Have you been convicted of a felony?

If yes, please explain (a conviction will not automatically bar employment)

Any offer of employment is contingent upon completing a criminal background screening.

If selected for employment are you willing to submit to a pre-employment background screening and drug screening test?

Education

High School

Name & Address

Phone

Years Completed?

Graduated?

College

Name & Address

Phone

Years Completed?

Graduated?

Degree Type

Other Training or School

Employment Desired

Position applied for

Have you ever applied here before?

Have you worked for Pete and Gerry’s or Rooster Cruiser before?

If yes, did you leave on good terms?

Are you available for full-time work?

Are you available for part-time work?

Are you willing to work overtime as needed?

Do you have reliable transportation?

Employment History

Please list 3 previous jobs.

First Position

Employer:

Work #:

Address:

Date Started:

Date Ended:

Position:

Rate of Pay Start:

Rate of Pay End:

Duties Performed:

Supervisor Name:

May we contact them?

Reason for Leaving:

Second Position

Employer:

Work #:

Address:

Date Started:

Date Ended:

Position:

Rate of Pay Start:

Rate of Pay End:

Duties Performed:

Supervisor Name:

May we contact them?

Reason for Leaving:

Third Position

Employer:

Work #:

Address:

Date Started:

Date Ended:
]

Position:

Rate of Pay Start:

Rate of Pay End:

Duties Performed:

Supervisor Name:

May we contact them?

Reason for Leaving:

Other Experience

In addition to your work history, are there any other skills, qualifications, or experience that we should consider?

References

List three references, not related to you, whom you have known for more than one year.

First Reference

Name:

Phone:

Years Known

Address:

Second Reference

Name:

Phone:

Years Known

Address:

Third Reference

Name:

Phone:

Years Known

Address:

Acknowledgement And Authorization

I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.

All employees of Pete and Gerry’s Organics are employed on an at-will basis, meaning that employees are free to resign from employment at any time for any reason. Likewise, Pete and Gerry’s Organics can terminate the employment relationship at any time, for any reason. This employment application is not intended to change the at-will relationship or create a contract of employment or benefit.

I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that persons need for a reasonable accommodation as required by the ADA.

I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment.

I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.