Belle Mead Farmers Llc

Today’s Date ______/_____/______

BELLE MEAD FARMERS LLC, d.b.a. BELLE MEAD CO-OP (908) 359-5173 Fax (908)359-7232 [email protected]

Job Application

PERSONAL INFORMATION:

First Name ______Middle initial ____Last Name ______

Street Address ______

City, State, Zip Code ______

Phone Number (___) ______Cell Phone#______(Please be neat with phone numbers. If I can’t read your number I can’t call you!)

E-Mail Address ______

Are you eligible to work in the United States? Yes ______No______

If you are under age 18, do you have an employment/age certificates? Yes ___ No ___

POSITION: Position Applied For______

AVAILABILITY: What date are you available to start work? ______

We are open from 7:30 to 6:00 M-F, Sat 7:30 to 5:00, Sunday 9:00 to 4:00.

AVAILABILITY: Please complete the table below if there are any restrictions to your schedule. Circle the situation the best applies to your availability.

Open no restrictions High school College Sports Other ______.

Saturday Sunday Monday Tuesday Wednesday Thursday Friday Available: Available: Available: Available: Available: Available: Available: from from from from from from from ______to ______to ______to ______to ______to ______to ______to ______

EDUCATION: Name and Address of School - Degree/Diploma - Graduation Date ______

Skills and Qualifications: Licenses, Skills, Training, Awards ______

EMPLOYMENT HISTORY:

Present Or Last Position: Employer: ______

Address:______

Supervisor: ______Phone: ______

Email: ______Position Title: ______

From: ______To: ______Responsibilities: ______

______

Salary: ______Reason for Leaving: ______

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Prior: Employer: ______

Address:______

Supervisor: ______Phone: ______

Email: ______Position Title: ______

From: ______To: ______Responsibilities: ______

______

Salary: ______Reason for Leaving: ______

May We Contact Your Present Employer? Yes _____ No _____

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.

Signature______Date______