KRETSCHMANN FARM

257 ZEIGLER RD., ROCHESTER, PA 15074

(724)452-7189

E-mail: don@kretschmannfarm.com

www.kretschmannfarm.com

APPLICATION FOR EMPLOYMENT

DATE OF APPLICATION:

APPLICANT INFORMATION

Last Name:		First Name:	Date of Birth:
Mailing Address:
City:	State:	Zip:	Country:
Day Phone:	Evening Phone:	Cell Phone:	Email Address:
Social Security Number:	Driver’s License Number:	Marital Status:	Children:

1. Are you available for full-time work? Yes No

2. If hired, can you provide documents required to prove that you are currently legally authorized to work in the United States? Yes No

3. If employed and you are under 18, can you furnish a work permit? Yes No

4. Have you ever been disciplined, suspended, fired, or asked to resign from any position? If yes, give details.

5. Have you ever had your driver’s license suspended or revoked?

6. Please list all moving violations (tickets) which you have received within the last five years; seven years if alcohol/drug related violations such as DUI, DWI etc.

DATE TYPE (Speeding, etc) DESCRIBE

7. Have you had any traffic accidents on or off job within the last five years?

DATE DESCRIBE

8. Have you ever been convicted of, plead guilty to, or no contest to a misdemeanor or felony charge other than a traffic violation? If yes, give details (Date, Offense, Disposition).

9. Do you presently have a misdemeanor or felony charge pending (includes delayed sentence, suspended sentence or diversion program)? If yes, give details (Date, Offense, and Location).

10. This job requires strenuous physical labor. A) Do you have any physical limitations, handicaps, or health problems that could prevent you from performing strenuous physical labor?

If yes, explain:

B) Are you willing to undergo a physical examination to verify the above information?

EDUCATION AND TRAINING

Educational Level: Circle highest level completed.

Did Not Complete High School/GED Post High School, Vocational or Business School Diploma Completed GED Bachelor’s Degree

Graduated From High School Some Graduate Degree Courses

Some College, Less Than BA or BS Degree Graduate College Degree

Two-Year Associate Degree PHD College Classes/Degree

School Type	School Name	City/State	Major	Dates Attended	Graduated? Yes or No	Degree/Certificate Earned
High School
College
College
College
Bus/Tech
Other

SPORTS/ EXTRACURRICULAR PARTICIPATION:

HOBBIES, MUSICAL INSTRUMENTS:

MILITARY EXPERIENCE

Branch of Service:

Position:

Dates:

Rank at Date of Discharge:

Type of Discharge:

Additional Information:

OCCUPATIONAL LICENSES, REGISTRATION, CERTIFICATES

(INCLUDE COMMERCIAL DRIVER’S LICENSE)

ISSUED BY FIELD/TRADE/SPECIALIZATION LICENSE/CERTIFICATION # ISSUE DATE EXPIRATION DATE

__________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

EMPLOYMENT HISTORY

List ALL employment history, most recent first. Additional sheets may be attached if necessary.

Employer		Telephone #:	Email Address:
Address:			Supervisor’s Name:	Job Title:
Date Hired:	Date Left:	Reason for Leaving:	Average Hours Per Week:	Number of Employees Supervised:
Job Description/Duties:

Employer		Telephone #:	Email Address:
Address:			Supervisor’s Name:	Job Title:
Date Hired:	Date Left:	Reason for Leaving:	Average Hours Per Week:	Number of Employees Supervised:
Job Description/Duties:

Employer		Telephone #:	Email Address:
Address:			Supervisor’s Name:	Job Title:
Date Hired:	Date Left:	Reason for Leaving:	Average Hours Per Week:	Number of Employees Supervised:
Job Description/Duties:

Employer		Telephone #:	Email Address:
Address:			Supervisor’s Name:	Job Title:
Date Hired:	Date Left:	Reason for Leaving:	Average Hours Per Week:	Number of Employees Supervised:
Job Description/Duties:

May we contact former employers if you are being considered for a position? Yes No

PROFESSIONAL REFERENCES

List three or more references other than relatives or employers.

NAME ADDRESS PHONE OCCUPATION RELATIONSHIP

In case of emergency, please notify:

NAME ADDRESS PHONE

ADDITIONAL INFORMATION

Additional sheets may be attached if necessary.

1. Describe any previous experience, knowledge, or skills that would qualify you for this work.

2. Describe your expertise in any of the following areas: construction, heating/cooling, welding, plumbing, and mechanics.

3. Describe your expertise in any of the following areas: fruit production, greenhouse production, and vegetable production.

4. Describe your expertise in the following areas: accounting, bookkeeping, computers, and creative writing. Include list of computer programs you are proficient using and your skill level.

5. Describe your expertise in the following areas: delivery truck driving and customer service.

6. Describe your experience working as a member of a team.

7. List any other special skills or qualifications relevant to the position applied for.

8. What would you say your ‘strong suit’ in the workplace is?

9. What are some of your goals in career and life?

10. How will working here fit your goals?

PLEASE ATTACH RESUME

CERTIFICATION STATEMENT

I certify that the information I have provided in this application and any attachments is true and accurate to the best of my knowledge and contains no willful falsifications or misrepresentations. I understand that I may be required to verify the information before being appointed. I understand that any falsifications or misrepresentations may disqualify me from employment consideration; or if hired, may be grounds for termination. I acknowledge that consideration for employment will be contingent on the results of a reference and background check. By submission of this application, I am authorizing the Kretschmann Farm to conduct a criminal history check as part of the pre-employment screening process. Upon request I may be required to submit proof of my educational credentials, professional certifications, or evidence of membership in professional organizations. I understand that if employed I will be asked to provide verification of identity and proof of the right to work in the U.S. I hereby certify that the statements on this application are true and correct to the best of my knowledge.

I agree. I disagree.

SIGNATURE: DATE