KRETSCHMANN FARM
257
ZIEGLER RD. (724)
452-7189
ROCHESTER, PA 15074 e-mail:kmann@usaor.net
EMPLOYEE APPLICATION DATE:
1. NAME: DATE OF BIRTH: MARITAL STATUS:
2. ADDRESS: CHILDREN:
3. TELEPHONE: 4. SOCIAL SECURITY #
E-MAIL:
5. SCHOOLS ATTENDED: DATE ATTENDED: GRADUATED:
6. SPORTS/ EXTRACURRICULAR
PARTICIPATION:
7. HOBBIES, MUSICAL INSTRUMENTS:
8. PREVIOUS EMPLOYERS (FROM MOST
RECENT):
DATE NAME ADDRESS PHONE JOB DESCRIPTION/DUTIES
A.
B.
C.
D.
May we contact former employers?
9. 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?
10. Describe previous experience,
knowledge, or skills that would qualify you for this work.
11. Do you have expertise in any of the
following areas: Accounting,
construction, heating/cooling, welding, plumbing, mechanics, computers, fruit
production, creative writing?
12. Drivers license #:
13. Have you ever had your drivers
license suspended or revoked?
14. Have you had any traffic accidents
on or off job within the last five years?
Describe: Date:
15. Have you ever been convicted of a
criminal offense?
16. Please list all moving violations
(tickets) which you have recieved within the last five years- seven years if
alcohol/drug related violations such as DUI, DWI etc.
DATE TYPE
(Speeding, etc) DESCRIBE
17. List three or more references other
than relatives or employers.
NAME
ADDRESS PHONE
18. In case of emergency, please
notify:
NAME
ADDRESS PHONE
19. What are some of your goals in
career and life?
20. How will working here fit your
goals?
21. What would you say is your
"strong suit" in the workplace?
22. Resume.
SIGNATURE: DATE