For Office Use Only

Date Entered in SAP: _______ Initials ______

Prep. to Hire date: _________ Initials ______

Hire Date: ________________ Initials ______

TURKEY VALLEY FARMS

APPLICATION FOR EMPLOYMENT

(Please print plainly in ink or type. Note that there is a “Certificate and Agreement” on the last page that you are required to sign.)

Notice to All Applicants

Post Offer Applicants Must Successfully Pass a Drug/Alcohol Screening Test as a Condition of Employment

PERSONAL Date: ______________

Name___________________________________________________ Social Security No._______________________

Last First Middle Initial

Present Address_______________________________________________________________________________________

Address City State County Zip

How Many years have you lived at this address?______________ Telephone No. ( ) ______________________ Area

Previous Address_________________________________________________ How long did you live there? _______

Address City State County Zip

Job(s) applied for 1. ____________________________ Rate of pay Expected $_____________ per ____________

2. ____________________________ Rate of pay Expected $_____________ per ____________

Do you want to work: ___ Full Time ___ Part Time?

Available for: ___ Days ___ Evenings ___ Nights ___ Weekends

Have you ever worked for Turkey Valley Farms before? ___________ If yes, when/where ______________________

If hired, on what date will you be available for work? ____________________________________________________

Do you have any special experiences, skills, or qualifications that particularly fit you for work with this Company? ____

______________________________________________________________________________________________

______________________________________________________________________________

Have you ever been convicted of a felony?

(conviction does not automatically bar an applicant from consideration)_________________________

MILITARY SERVICE RECORD

Have you ever served in the armed forces? ______ Yes ______ No

If yes, which branch? ______________________________________ Rank at discharge? ______________________

What were your major duties in the Service (include special training and duty station) __________________________

______________________________________________________________________________________________

Have you had any schooling under the G.I. Bill of Rights? ______ Yes ______ No If yes, describe __________

______________________________________________________________________________________________

______________________________________________________________________________________________

PERSONAL REFERENCES

(Excluding former employers or relatives)

NAME

OCCUPATION

ADDRESS

PHONE NUMBER

WORK HISTORY (LIST IN ORDER - - LAST OR PRESENT EMPLOYER FIRST)

(Complete this section even if you are submitting a resumé)

EMPLOYMENT	Please give accurate, complete full-time & part-time employment record. Start with present or most recent employer.
(1) Company Name	Telephone ( )
Address	Employed (State Month & Year) From To
Name of Supervisor	Rate of Pay Start Last
Job Title and Summary of Duties	Reason for Leaving

EMPLOYMENT	Please give accurate, complete full-time & part-time employment record. Start with present or most recent employer.
(2) Company Name	Telephone ( )
Address	Employed (State Month & Year) From To
Name of Supervisor	Rate of Pay Start Last
Job Title and Summary of Duties	Reason for Leaving

EMPLOYMENT	Please give accurate, complete full-time & part-time employment record. Start with present or most recent employer.
(3) Company Name	Telephone ( )
Address	Employed (State Month & Year) From To
Name of Supervisor	Rate of Pay Start Last
Job Title and Summary of Duties	Reason for Leaving

EMPLOYMENT	Please give accurate, complete full-time & part-time employment record. Start with present or most recent employer.
(4) Company Name	Telephone ( )
Address	Employed (State Month & Year) From To
Name of Supervisor	Rate of Pay Start Last
Job Title and Summary of Duties	Reason for Leaving

May we contact the employers listed above? _______ If no, indicate which one(s) you do not wish us to contact.

______________________________________________________________________________________________

EDUCATIONAL BACKGROUND

Type of School	Name, City and State of School	Course or Major	Graduated
High School			___ Yes ___ No
GED			___ Yes ___ No
Grad School			___ Yes ___ No
College	Overall GPA ____________		___ Yes ___ No Type of Degree
Post Graduate	Overall GPA ____________		___ Yes ___ No Type of Degree
Business or Trade			___ Yes ___ No

We are an equal opportunity Employer

It has been and will continue to be the policy of Turkey Valley Farms to be an equal opportunity employer. Our objective is to recruit, hire, train and promote onto all job levels the most qualified applicants without regard to race, color, marital status, sexual orientation, status with regard to public assistance, religion, sex, national origin, age, disability, or veteran’s status.

This Application Will Be Considered Active for 90 days

PLEASE READ CAREFULLY

APPLICANT’S CERTIFICATION AND AGREEMENT

I certify that the information contained in this application is true and complete to the best of my knowledge. I understand that any false statement or omission of information on this application is sufficient cause for rejecting me for employment with Turkey Valley Farms, or, if I am employed by Turkey Valley Farms, is sufficient cause for dismissal.

You are authorized to make any investigation of my personal, work, financial, criminal record and credit history by an investigative or credit agency or by the Company. I release former employers, their companies, and any other parties from all liability for any damage that may result from furnishing information to you concerning me. Further, if I become employed by Turkey Valley Farms, I agree to submit to employment-related medical examinations, when reasonable and necessary, the request of Turkey Valley Farms.

Also, as an aid to fully comply with Federal and State employment laws, I authorize Turkey Valley Farms to contact any government agency including, but not limited to, the Social Security Administration and Immigration & Naturalization Service to verify employment eligibility and/or document validity.

I release all parties from all liability for any damage that may result from furnishing the requested information. This authorization is valid not only at the time of my application for employment, but is continuous authorization good throughout my employment with Turkey Valley Farms or any subsidiary thereof.

I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any prior notice.

In consideration of my employment, I agree to comply with the rules and regulations of Turkey Valley Farms, and agree that my employment can be terminated with or without cause, and with or without notice, at the option of either the Company or myself. I understand that no representative of the Company (other than the President or Chairman of the Board) has any authority to enter into any agreement or contract for employment for any specific period of time, or to make any agreement or contract contrary to the foregoing.

Applicant’s Signature: ________________________________ Date: __________________