| GENERAL |
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* Social Security # |
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* Date:
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* Name:
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(Last / First / Middle)
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* Address:
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(No. Street / City / State / Zip)
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* Telephone:
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Cell:
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Email Address:
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* Are you 18 years of age or older:
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* If hired, can you provide written evidence that you are authorized to work in the U.S.?:
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| EDUCATION |
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| EMPLOYMENT RECORD |
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| U.S. MILITARY SERVICE |
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Branch of Service:
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From
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to
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Rank and Type of Service:
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Training/Experience Received:
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| REFERENCES (Do Not Include Relatives) |
| Name, Years Known and Phone Number |
* 1.
2.
3.
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| EMPLOYMENT |
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Type of Work Desired or Position Applying For:
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Dates Available:
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* Salary Desired:
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How Were You Referred To Our Organization?:
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* Do You Have Any Previous Injuries Or Work Restrictions?
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If Yes, Please Specify:
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* Is there any information we would need about your name,
or use of another name, for us to be able to check your work record ?
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Please Specify:
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Please list any additional information that relates to your ability to perform the job for which you have applied such as licenses, professional memberships, hobbies, etc.
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APPLICANT'S STATEMENT/AGREEMENT/AUTHORIZATION
I understand that The Mustard Seed, Inc. follows an employment at will policy, in that I or The Mustard Seed, Inc. may
terminate my employment at any time, or for any reason consistent with applicable state or federal law; this employment
at will policy cannot be changed verbally or in writing, unless the change is specifically authorized in writing by the chief
operating officer of this organization. I understand that this application is not a contract of employment. I understand that
federal law prohibits the employment of unauthorized aliens; all persons hired must submit satisfactory proof of
employment authorization and identity; failure to submit such proof will result in denial of wages.
I hereby agree that if I am hired and later choose to sever my employment with The Mustard Seed, Inc., I will give a
minimum of two weeks written notice of intent to terminate employment or accept minimum allowed wages for all days or
hours owed me. I understand this application will be active for a period of one year; after that time, if I wish to be
considered for employment, I must submit a new application.
I understand that The Mustard Seed, Inc. may thoroughly investigate my work and personal history and verify all data
given on this application, on related papers, and in interviews. I authorize all individuals, schools, and firms named
therein, except my current employer if so noted, to provide any information requested about me, and I release them from
all liability for damage in providing this information.
I certify that all the statements herein are true and understand that any falsification or willful omission shall be sufficient
cause for dismissal or refusal of employment.
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