35 Employment Application Employment ApplicationPrint Blank Application "*" indicates required fields Part 1: Tell Us About YourselfFull Name* Last First MI Date* MM slash DD slash YYYY Address* Street Address Apartment/Unit # City State / Province / Region ZIP / Postal Code Phone*Email* Date Available to Start*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Desired Salary*Position Applied For*Are you a United States Citizen?* Yes No If not, are you authorized to work in the U.S.?* Yes No Have you ever worked at Farifax Food Service?* Yes No If yes, when?Have you ever been convicted of a felony?* Yes No If yes, explain:Part 2: EducationHigh SchoolAddress City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Did you graduate? Yes No Dates AttendedCollegeLocation City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Did you graduate? Yes No Dates AttendedOther Education (describe)Part 3: Professional ReferencesFull Name First Last RelationshipCompanyPhoneAddress Street Address Professional Reference #2Full Name First Last RelationshipCompanyPhoneAddress Street Address Professional Reference #3Full Name First Last RelationshipCompanyPhoneAddress Street Address Part 4: Past EmploymentCompanyPhoneAddress Street Address SupervisorJob TitleStarting SalaryEnding SalaryResponsibilitiesStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Reason for LeavingMay we contact your previous supervisor? Yes No Past Employer #2CompanyPhoneAddress Street Address SupervisorJob TitleStarting SalaryEnding SalaryResponsibilitiesStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Reason for LeavingMay we contact your previous supervisor? Yes No Past Employer #3CompanyPhoneAddress Street Address SupervisorJob TitleStarting SalaryEnding SalaryResponsibilitiesStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Reason for LeavingMay we contact your previous supervisor? Yes No Part 5: Military ServiceHave you served or do you serve now in the U.S. military? No Yes BranchStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Rank at DischargeType of DischargeIf other than honorable, explainPart 6: Disclaimer and SignatureRead this carefully. 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 authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws. I understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, the company will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. Type your name to agree and certify the above.*Date* MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged. Δ