EDGEWATER ORCHARDS, INC.

Employment Application

Programs, services and employment are equally available to everyone. Please inform the Human Resources Department if you require reasonable accommodation for the application or interview.

Date_____________

APPLICANT DATA:

Full Name:____________________________________________________________________

Address:______________________________________________________________________

Phone :_( )_______________Cell/other phone_______________________________________

Date available to start:________________Social Security #:_____________________________

If you are under 18, we require parent and school permission to work. Will this present any problems? ______ No ______Yes

If yes, please explain: ____________________________________________________________

Have you ever worked for this company? _____No ______Yes If yes, when? ____________

Type of employment desired: ______Full-time ________Part Time _______Seasonal

Position you are applying for: _____________________________________________________

Have you ever pled “guilty”, “no contest”, or been convicted of a crime? ______No ______Yes

If yes, give dates and details: ______________________________________________________

______________________________________________________________________________

Answering “yes” to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation rehabilitation, and position applied for will be considered.

Do you have a valid Washington state driver’s license? ______No_________Yes Number: ________________________

Who referred you to us? __________________________________________________________

EDUCATION:

High School___________________________________________________________________
# of Years completed: ______________ Did you Graduate?___________

College/University: _____________________________________________________________

# of Years completed: ______________ Did you Graduate? ___________

Other: __________________________________________________________________________

# of Years completed: ______________ Did you Graduate? ____________

REFERENCES:

Please furnish the names, addresses and telephone numbers of two people to whom you are not related and by whom you have not been employed:

Name: ______________________________________________Phone:____________________

Address: _____________________________________________________________________

Name: ______________________________________________Phone:____________________

Address: ______________________________________________________________________

SUMMARIZE YOUR SPECIAL SKILLS OR QUALIFICATIONS:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PREVIOUS EMPLOYMENT (begin with most recent position):

Dates of Employment: From: ________ To: _________ Position(s) Held: ________________

Firm: __________________________________ Address: ______________________________
Phone: ______________________Supervisior:_____________________Title:______________

Responsibilities: ________________________________________________________________

______________________________________________________________________________

Starting Salary & Title: ________________________Ending Salary & Title________________

Reason for leaving: _____________________________________________________________

May we contact this employer for a reference? _________No _______Yes

Dates of Employment: From: ________ To: _________ Position(s) Held: ________________

Firm: __________________________________ Address: ______________________________
Phone: ______________________Supervisior:_____________________Title:______________

Responsibilities: ________________________________________________________________

______________________________________________________________________________

Starting Salary & Title: ________________________Ending Salary & Title________________

Reason for leaving: _____________________________________________________________

May we contact this employer for a reference? _________No _______Yes

Dates of Employment: From: ________ To: _________ Position(s) Held: ________________

Firm: __________________________________ Address: ______________________________
Phone: ______________________Supervisior:_____________________Title:______________

Responsibilities: ________________________________________________________________

______________________________________________________________________________

Starting Salary & Title: ________________________Ending Salary & Title________________

Reason for leaving: _____________________________________________________________

May we contact this employer for a reference? _________No _______Yes

I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, education, financial, or medical history and other related matters as may be necessary for an employment decision. I hereby release employer, schools or persons from all liability when responding to inquires in connection with my application.

In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.

I understand that completion of this application for employment offers no commitment on the part of the employer for above stated position or any other position.

Applications will remain active for 90 days. Applicants must renew their applications after that time period in order to be considered for other job openings.

Documentation proving legal right to work in the United States will be required upon hiring.

Signature of Applicant:____________________________Date:______________________