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Capay Farms
Capay Farms Employment Application
An Equal Opportunity Employer
Name
*
First Name
Last Name
Email
*
Present Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Permanent Address (if different from present address)
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Business Phone
(###)
###
####
Home Phone
(###)
###
####
Cell Phone
*
(###)
###
####
Employment Desired
Position Applying For:
Date you can start
MM
DD
YYYY
Salary Desired
$
Personal Information
Have you ever applied to or worked for Capay Farms before?
YES
NO
If yes, when?
Do you have any friends or family working for Capay Farms?
YES
NO
If yes, state their names and your relationship to them.
If hired, would you have a reliable means of transportation to and from work?
YES
NO
Are you at least 18 years old?
If under 18, hire is subject to verification of minimum legal age.
YES
NO
If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country?
YES
NO
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accomodation?
YES
NO
If no, describe the functions that cannot be performed.
Note: We comply with the ADA and consider reasonable accomodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and skill and agility tests.
Education, Training, and Experience
Name and Address of School/Training Facility
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Number of Years Completed
Did you graduate?
YES
NO
Degree/Diploma:
Name and Address of School/Training Facility
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Number of Years Completed
Did you graduate?
YES
NO
Degree/Diploma:
Have you worked with any equipment?
YES
NO
If yes, what equipment and how long did you work with it?
Employment History
List below all present and past employment starting with your most recent employer (last 5 years is sufficient). Account for all periods of unemployment. You must complete this section even if attaching a resume.
Name of Employer
Type of Business
Telephone Number
(###)
###
####
Name of Supervisor
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Dates of Employment
Fron
MM
DD
YYYY
To
MM
DD
YYYY
Your Position and Duties
Reason for Leaving
May we contact this employer for a reference?
YES
NO
Name of Employer
Type of Business
Telephone Number
(###)
###
####
Name of Supervisor
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Dates of Employment
From
MM
DD
YYYY
To
MM
DD
YYYY
Your Position and Duties
Reason for Leaving
May we contact this employer for a reference?
YES
NO
References
List below 3 persons not related to you who have knowledge of your work performance within the last 3 years.
Name
*
First Name
Last Name
Telephone Number
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Occupation
*
Number of Years
*
Name
*
First Name
Last Name
Telephone Number
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Occupation
*
Number of Years
*
Name
*
First Name
Last Name
Telephone Number
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Occupation
*
Number of Years
*
Please Read Carefully, Initial Each Paragraph and Sign Below
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
*
Initials:
I hereby authorize Capay Farms to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further authorize the references I have listed to disclose to the company and any other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
*
Initials:
I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the Company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the Company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the Company's designated rep.
*
Initials:
Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment) be conducted by internal personnel employed by the Company, I am entitled to copies of any such public records obtained by the Company unless I mark the box below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have marked the box below.
*
Initials:
I waive receipt of a copy of any public record described in the paragraph above.
*
Today's Date
MM
DD
YYYY
Applicant's Name (in lieu of signature)
Thank you!
