311 Muse Road
Gore, VA 22637
(540) 858-3207
FAX: (540) 858-2888
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Employment
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Indicates required field
Application for Employment
Date
*
We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, disability, or national origin. Consistent with the Americans with disabilities act, applicants may request accommodations needed to participate in the application process.
Personal Information
Name
*
As your name appears on your Social Security card, please.
Social Security Number
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
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Referred by:
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Emergency Contact Person
Name
*
First
Last
Phone Number
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Are You 18 Years Old or Older?
*
Yes
No
Do You Speak a Different Language?
*
Yes
No
Have You Ever Been Convicted of a Felony?
*
Yes
No
(Please not that the existence of any conviction or criminal history does not necessarily preclude employment.
If Yes, Please Give Details
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Employment Desired
Position
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Date You Can Start
*
Salary Desired
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Are You Employed Now?
*
Yes
No
If Yes, May We Inquire Your Present Employer?
*
Yes
No
Have You Ever Applied to this Company Before?
*
Yes
No
If Yes, When?
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Available for Work
Monday
*
Yes
No
Start Time
*
End Time
*
Select if Unavailable
*
Can Not Work
Only check if you can not work
Tuesday
*
Yes
No
Start Time
*
End Time
*
Select if Unavailable
*
Can Not Work
Only check if you can not work
Wednesday
*
Yes
No
Start Time
*
End Time
*
Select if Unavailable
*
Can Not Work
Only check if you can not work
Thursday
*
Yes
No
Start Time
*
End Time
*
Select if Unavailable
*
Can Not Work
Only check if you can not work
Friday
*
Yes
No
Start Time
*
End Time
*
Select if Unavailable
*
Can Not Work
Only check if you can not work
Saturday
*
Yes
No
Start Time
*
End Time
*
Select if Unavailable
*
Can Not Work
Only check if you can not work
Sunday
*
Yes
No
Start Time
*
End Time
*
Select if Unavailable
*
Can Not Work
Only check if you can not work
PLEASE NOTE THAT THIS JOB MAY REQUIRE THE LIFTING OF 50LB OR MORE ON A REGULAR BASIS, STANDING FOR A PROLONG TIME, BENDING, AND GENERAL PHYSICAL MOTION.
Education
Name of High School
*
Last Year Completed
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Did You Graduate?
*
Yes
No
Subjects Studied & Degrees Received
*
Name of College
*
Last Year Completed
*
Did You Graduate?
*
Yes
No
Subjects Studied & Degrees Received
*
Name of Trade, Business or Correspondence School
*
Last Year Completed
*
Did You Graduate?
*
Yes
No
Subjects Studied & Degrees Received
*
General
Subject of Special Study or Research Work
*
Job-Related Skills (Forklift Exp, Tractor Exp, Driver's License, Etc.
*
Former Employer
Name & Address of Employer
*
Start Date
*
End Date
*
Salary (Upon Leaving)
*
Position
*
Reason for Leaving
*
Name & Address of Employer
*
Start Date
*
End Date
*
Salary (Upon Leaving)
*
Position
*
Reason for Leaving
*
Name & Address of Employer
*
Start Date
*
End Date
*
Salary (Upon Leaving)
*
Position
*
Reason for Leaving
*
References
List below, three persons not related to you, whom you have known for at least one year.
Name
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Position
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Phone Number
*
Years Acquainted
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Name
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Position
*
Phone Number
*
Years Acquainted
*
Name
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Position
*
Phone Number
*
Years Acquainted
*
Acknowledgement
“BY CHECKING THE BOX BELOW, I AUTHORIZE INVESTIGATION ON ALL STATEMENTS CONTAINED IN THIS APPLICATION. I UNDERSTAND THAT MISREPRESENTATION OF INFORMATION REQUESTED IS CAUSE FOR DISMISSAL. FURTHER, I UNDERSTAND AND AGREE THAT 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 CASE AND WITHOUT ANY PREVIOUS NOTICE”
I Authorize
*
Yes
Date
*
EQUAL EMPLOYMENT OPPORTUNITY FORM
APPLICANT INFORMATION / VOLUNTARY INFORMATION
THE COMPLETION OF THIS FORM IS VOLUNTARY. THIS INFORMATION IS BASIC INFORMATION, IT IS IN NO WAY USED TO DETERMINE EMPLOYMENT WITH TIMBER RIDGE FRUIT FARM, LLC.
Name
*
First
Last
MI
*
Nickname
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Cell Number
*
Social Security Number
*
Date of Birth
*
Driver's License Number/ID Number
*
Gender
*
Male
Female
Racial or Ethnic Group
*
AMERICAN INDIAN/ALASKAN
ASIAN/PACIFIC ISLANDER
BLACK/AFRICAN AMERICAN
HISPANIC/LATINO
WHITE/CAUCASIAN
OTHER
If available, would you be interested in direct deposit?
*
Yes
No
Submit
