Application Form

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BASS FARMS APPLICATION FORM

Date of Application:

Personal

First Name:

Last Name:

Middle Name:

Street Address:

City:

State:

Zip:

Phone Number:

Email:

Social Security #:

Are you 18 years of age or older? YesNo

Are you legally able to work in the U.S.? YesNo

Are you a military Veteran? YesNo

If yes, Dates of active duty:
to

Have you ever been known by any other name(s) that this company will require to verify any other information on this application?

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Employment Desired

Job Title:

Date you can start:

Wage Desired:

Are you available for work Full-TimePart-TimeShift WorkSeasonal

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Education

Do you have a High School Diploma or GED? YesNo

Name of last school attended:

City:

State:

Select last year of school completed? 6789101112131415161718

Select the highest degree earned? HS DiplomaGEDCertificateAABDMDPHDOther

Area of Concentration and/or degree(s), certificates, licenses, endorsements:

Other training or skills (factory or office machines operated, special courses, computer skills, etc.):

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Employment History

Former Employment (List employers, starting with the current or most recent.)

Employer

Company Name:

Job Title:

Street Address:

City:

State:

Zip:

Start Date:

End Date:

Rate of Pay:

Detailed Job Duties:

Reason for leaving:

Employer

Company Name:

Job Title:

Street Address:

City:

State:

Zip:

Start Date:

End Date:

Rate of Pay:

Detailed Job Duties:

Reason for leaving:

Employer

Company Name:

Job Title:

Street Address:

City:

State:

Zip:

Start Date:

End Date:

Rate of Pay:

Detailed Job Duties:

Reason for leaving:

May we contact your former employers to verify this information? YesNo

May we contact your present employer? YesNo

Please provide any additional information about your abilities or interests that make you a good candidate for this position:

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Authorization

I authorize investigation of all statements contained in the application. I understand that omission or misrepresentation of facts is cause dismissal.

Date:

Full Name:

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