Employment Application | Valley Cooperative Association

Full Name

Date

Email Address

Address

City

State

Zip Code

Phone Number

Date Available

Position Applied for

How did you hear about Valley Bakers?

Are you 18 years of age or older?

Yes

No

Are you authorized to work in the U.S.?

Yes

No

Have you ever worked for this company?

Yes

No

If yes, when?

Have you ever been convicted of a felony?

Yes

No

If yes, please explain:

Education

High School

Did you graduate?

Yes

No

Degree

College

Did you graduate?

Yes

No

Degree

Special Skills

Past Employment - Please use "Add" button to list all employers for the past 10 years

Company

Address

Supervisor

Phone Number

Job Title

Starting Salary

Ending Salary

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

No

Add Remove

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I also understand that a pre-employment drug screen will be conducted and a positive test may result in the rescindment of the original job offer.

Signature

Date