Application For Employment

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Please answer all questions. Resumé’s are not a substitute for a completing an application.

We are an equal opportunity employer. Applicants are considered for positions without regard to race, religion, sex, national origin, age, disability or any other category protected by applicable federal, state or local laws.

THIS COMPANY IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE.

Position Applied For(Required)

First Name:(Required)

Last Name:(Required)

Phone number you can be reached at:(Required)

Alternate number:(Required)

Present Address:(Required)

Previous Address:(Required)

Emergency Contact Name:(Required)

Phone Number:(Required)

Relationship:(Required)

Desired Salary/Hourly rate: $(Required)

Date you can start work, if hired:(Required)

Are you available to work:(Required)

Full time:(Required)

Part-time:(Required)

Overtime:(Required)

Have you previously applied or worked for this company?(Required)

If yes, when:(Required)

EDUCATION:

High School Name:(Required)

Diploma:(Required)

GED:(Required)

College:(Required)

Degree/Major:(Required)

Please list any technical skills you have that you feel would qualify you for the position you are applying for:(Required)

WORK EXPERIENCE: Please start with most recent

Previous Employer:(Required)

Address:(Required)

Phone Number:(Required)

Dates of Employment: from(Required)

DOE: to(Required)

Job Title:(Required)

Duties:(Required)

Supervisor’s Name:(Required)

May we contact:(Required)

Yes

Wage start: $(Required)

Finish: $(Required)

Reason for leaving:(Required)

Previous Employer:

Address:

Phone Number:

Dates of Employment: from

DOE: to

Job Title:

Duties:

Supervisor’s Name:

May we contact:

Yes

Wage start: $

Finish: $

Reason for leaving:

Previous Employer:

Address:

Phone Number:

Dates of Employment: from

DOE: to

Job Title:

Duties:

Supervisor’s Name:

May we contact:

Yes

Wage start: $

Finish: $

Reason for leaving:

Have you ever initiated an act of violence or been the victim of an act of violence in a workplace:

Yes

If yes, Please explain:

INSTRUCTIONS FOR ANSWERING THE NEXT TWO QUESTIONS:

All applicants: Do not include convictions that were sealed, eradicated, erased, annulled by a court; expunged or convictions that resulted in referral to a diversion program.

1. Have you ever plead guilty or no contest to, or been convicted of any criminal offense?(Required)

Yes

If yes, please explain:

2. Have you ever been arrested for any matters for which you are currently out on bail or on your own recognizance in a pending case?(Required)

Yes

If yes, please explain:

Criminal conviction or arrest will not automatically disqualify an applicant from being hired. North Country Smokehouse will consider the nature of the crime, it’s seriousness, the substantial relation to the position’s functions and qualifications, the number of occurrences, the applicant’s age at the time of crime, as well as any other circumstances.

REFERENCES:

Please list two (2) work-related references we may contact. If you have no previous work experience, please list two (2) school or volunteer references:

Name:(Required)

Phone Number:(Required)

Professional relationship:(Required)

Company:(Required)

Name:

Phone Number:

Professional relationship:

Company:

Please list two (2) personal references we may contact. Not including relatives.

Name:(Required)

Phone Number:(Required)

Relationship:(Required)

How many years known:(Required)

Name:

Phone Number:

Relationship:

How many years known:

APPLICATION CERTIFICATION

I understand and agree that if driving is a requirement of the job for which I am applying, my employment and/or continued employment is contingent on possessing a valid driver’s license for the state in which I reside and automobile liability insurance in an amount equal to the minimum required by the state where I reside.

I understand that the company may now have, or may establish, a drug-free workplace or drug and/or alcohol testing program a consistent with the applicable federal, state, and local law. If the company has such a program and I am offered a conditional offer of employment, I understand that if a pre-employment (post-offer) drug and/or alcohol test is positive, the employment offer may be withdrawn. I agree to work under the conditions requiring a drug-free workplace, consistent with applicable federal, state and local laws. I also understand all employees of the location, pursuant to the company’s policy and federal, state and local law, may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or illegal or controlled drugs. If employed, I understand that the taking of alcohol and/or drug tests is a condition of continual employment and I agree to undergo alcohol and drug testing consistent with the Company’s policies and applicable federal, state and local law.

If employed by the company, I understand and agree that the company, to the extent permitted by federal, state, and local law, may exercise its right, without prior warning or notice, to conduct investigations of property (including, but not limited to, filed, lockers, desks, vehicles and computers) and in certain circumstances, my personal property.

I understand and agree that as a condition of employment and to the extent permitted by federal, state and local law, I may be required to sign a confidentiality, restrictive covenant, and/or conflict of interest statement, as well as an agreement to arbitrate.

I certify that all the information on this application, my resume, or any supporting documents I my present during any interview is and will be complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action, up to and including immediate dismissal.

I agree to conform to the rules and regulations of the company, and I understand that the company has complete discretion to modify such rules and regulations at any time.

I authorize the company or its agents to confirm all statements contained in this application and/or resume as it relates to the position I am seeking and to the extent permitted by federal, state or local law. I agree to complete any requisite authorization form for a background investigation.

I authorize and consent to, without reservation, any party or agency contacted by this employer to furnish the above-mentioned information. I hereby release, discharge, and hold harmless, to the extent permitted by federal, state and local law, any party delivering information to the company or its duly authorized representative pursuant to this authorization from any liability, claims, charges, causes of action which I may have as a result of the delivery or disclosure of the above requested information. I hereby release from liability of the company and its representative for seeking such information and all other persons, corporations, or organizations furnishing such information.

If hired by this company, I understand that I will be required to provide genuine documentation establishing my identity and eligibility be legally employed in the United States by this company. I also understand this company employs only individuals who are legally eligible to work in the United States.

THIS APPLICATION WILL BE CONSIDERED ACTIVE FOR A MAXIMUM OF SIXTY (60) DAYS. IF YOU WISH TO BE CONSIDERED FOR EMPLOYMENT AFTER THAT TIME, YOU MUST REAPPLY.

I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE, ACCURATE AND COMPLETE.

Signature(Required)

Date(Required)

MM slash DD slash YYYY

Applicant Printed Name(Required)

EDUCATION:

REFERENCES:

APPLICATION CERTIFICATION

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EDUCATION:

REFERENCES:

APPLICATION CERTIFICATION

Subscribe to Smoke Signals

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