We provide food and services; create stability and further self-reliance for people in crisis

APPLICATION FOR EMPLOYMENT
To Applicant: We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will aid us in considering you for a position that best meets your qualifications. We consider applicants without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, veteran status, or any other legally protected status.
Position Applied For: / ______
How did you hear about us?
 Advertisement /  Employment Agency /  Relative /  Friend
 Walk-In /  Freestore Website /  Other

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

First Name: Middle Initial Last Name:
Maiden Name:
Street: City: State: Zip:
Home Phone: Cell Phone:
Email Address:
On what date would you be available to work? ______Salary expected
Are you available for:  Full time Part time  Temporary  Contractual
If you are under 18 years of age, can you provide required proof of your eligibility to work:  Yes  No
Have you ever file an application with us before? If yes, give date: ______ Yes  No
Have you ever been employed with us before? If yes, give date: ______ Yes  No
Are you currently employed?  Yes  No
Do you have any family members employed by the Freestore Foodbank?  Yes  No
If yes, give name ______Relationship: ______
Are you prevented from lawfully becoming employed in this country because of Visa or
immigration status? Proof of citizenship or immigration will be required upon employment  Yes  No
Are you currently on lay-off status and subject to recall?  Yes  No
If applying for a position that requires driving, do you have transportation, a valid  Yes  No
driver’s license and automobile insurance?
Have you been convicted of a crime (felony or misdemeanor) for the last 10 years?  Yes  No
Convictions will not necessarily disqualify an applicant from employment
If yes, please explain:

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disability or other protected status.

Employer Name: / Dates employed: (mm/yy) / Hourly Rate/Salary
From: / To: / From: / To:
Complete Address:
Supervisor Name and Title: / Phone: ( )
Job Title: /  Full time  Part Time
Work performed:
Reason for leaving: / If still employed, may we contact this employer?  Yes  No
Employer Name: / Dates employed: (mm/yy) / Hourly Rate/Salary
From: / To: / From: / To:
Complete Address:
Supervisor Name and Title: / Phone: ( )
Job Title: /  Full time  Part Time
Work performed:
Reason for leaving: / If still employed, may we contact this employer?  Yes  No
Employer Name: / Dates employed: (mm/yy) / Hourly Rate/Salary
From: / To: / From: / To:
Complete Address:
Supervisor Name and Title: / Phone: ( )
Job Title: /  Full time  Part Time
Work performed:
Reason for leaving: / If still employed, may we contact this employer?  Yes  No

List at least three professional referencesthat have knowledge of your work ethic, experience, and ability. (Do not include relatives.

Name Telephone Occupation

1.
2.
3.
School / Name and Location / Course of Study / # of years Completed / Year Graduated / List Diploma, Degree or Certifications*
High School / 1 2 3 4
Business/Trade/Technical / 1 2 3 4
College / 1 2 3 4
Other (Specify) / 1 2 3 4
(* If hired, you will be required to provide copies of degrees and certifications)
Bilingual Language
______
______
______ / Computer Skills: Skill Level Basic Intermediate Advance
Microsoft:
Word   
Excel   
PowerPoint   
Outlook   
Data Entry   
Other:   
Describe any specialized training, apprenticeship, skills and extracurricular activities:

Did you serve in the U.S. Armed Forces?  Yes  No Dates of duty: ______to ______

Branch: ______Applicable skills acquired: ______

JOB APPLICANT’S AGREEMENT AND CERTIFICATION

I certify that the information given by me in this application is true in all respects and agree that if the information given is found to be false in any way, it shall be considered sufficient cause for denial of employment or discharge. I authorize the use of any information in this application to verify my statements.

I authorized past employers, references and any other persons to answer all questions asked concerning my ability, character, reputation and previous employment record. I release all such persons from any liability or damages for have furnished such information.

I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract. No promise regarding employment has been made to me, and I understand that no such promise or guarantee is binding upon you.

I understand that if employed, policies and rules that are issued are not conditions of employment and that the Freestore Foodbank my revise policies or procedures, in whole or in part, at any time. The Freestore Foodbank reserves and retains the right to make changes in terms and conditions of my employment as the Freestore Foodbank determines to be appropriate.

I understand that this application will be kept on file for one year from the date completed, after which time I would have to reapply in accordance with established company procedures.

I understand that if employed with Freestore Foodbank, Inc. it is “at will” which means that my employment can be terminated with or without cause, and with or without notice, at any time, at the option of either the Freestore Foodbank, Inc. or myself, except as otherwise provided by law.

Applicant’s signature: ______Date: ______

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Human Resources and Volunteer Management Department

Rev. 11-1-10