Cashier/Grocery Clerk

CARLETON FARM, INC. 830 Sunnyside Blvd. SE Phone: 425.334.2297 Lake Stevens, WA 98258 Fax: 425.377.0137

Application for Employment

Please complete front and back in blue or black ink. Responses to questions on this application will be evaluated on their relevance to the position being sought. Carleton Farm is an equal opportunity employer.

Last Name First Middle

Address City State Zip

Home Telephone Cell

Position Interested In: ____Any Position or check all that apply ___Food Service ___Haunt Staff ___Event Attendant ___Farm Market ___Zombie Paintball ___Cashier ___Harvesting Staff Days/Hours available to work: (From/To for each day) Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Have you worked for Carleton Farm in the Past? Yes__ No__

If you are under age of 18, please provide your current age and date of birth: Age:____ DOB __/__/____

Are you a U.S. Citizen? Yes__ No__ If No, do you have the legal right and necessary documents to work in the U.S.? Yes__ No__

Were you ever discharged by any employer? Yes___ No___ If Yes, please give name of company and reason:______

Have you ever been convicted of a crime(other than minor traffic violation? Yes___ No___ If Yes, provide explanation of offense and final disposition______Turn Over------

Employeeapplication.doc 8/19/10 Education Level: School/City/State Degree/Area Study Year Graduated? Attended High School College Other Technical Skills (computer, software, register, POS, trade)

EMPLOYMENT HISTORY: (Pertinent only) If none, then list clubs & extra curriculars Dates Employer, Position Duties Wage Reason for Address & Phone leaving

REFERENCES Name Relationship Years Known Phone

PLEASE READ CAREFULLY: In submitting this Application for Employment, you agree that all information stated in this application is accurate and true. You also give permission to your prior employers and references to release information about you including work performance to Carleton Farm, Inc. as part of the hiring process.

Signature: ______Date: ______

Employeeapplication.doc 8/19/10