Online Application - Mountain View Mushrooms

Your Employment is subject to verification that you meet minimum legal age requirements and
that you are legally qualified to work in the United States of America.

Date

Position Applied For

Name*

Email*

Address (PO Box, Street, City, State, Zip)

Phone

Select Last Primary Grade Completed
123456789101112

Education

High School (School Name, Location, Years Completed, Type of Degree)

College/Vocational (School Name, Location, Years Completed, Type of Degree)

List job skills acquired / seminars attended / on the job training received / machines that you
can operate, etc. and level of proficiency.

Honors received/professional memberships/offices held:
(If you wish, you may exclude those, which may disclose your race, color, religion, national
origin, ancestry, gender, or age.)

Employment Record
Please list all employment positions beginning with your present or most current job. Please complete all blanks.

Most Recent Employment
Name of Firm

Address (Street, City, State)

Phone

Last Supervisor

Job Title

Employed From: To:

Starting Salary: per:

Ending Salary: per:

Specific Duties

Reason for Leaving

Prior Employment
Name of Firm

Address (Street, City, State)

Phone

Last Supervisor

Job Title

Employed From: To:

Starting Salary: per:

Ending Salary: per:

Specific Duties

Reason for Leaving

Prior Employment
Name of Firm

Address (Street, City, State)

Phone

Last Supervisor

Job Title

Employed From: To:

Starting Salary: per:

Ending Salary: per:

Specific Duties

Reason for Leaving

Prior Employment
Name of Firm

Address (Street, City, State)

Phone

Last Supervisor

Job Title

Employed From: To:

Starting Salary: per:

Ending Salary: per:

Specific Duties

Reason for Leaving

Miscellaneous

Verification of your legal right to work in the United States will be required after employment.
Will you be able to supply such verification?*
YesNo

Have you ever been employed at Mountain View Mushroom Farms?*
YesNo

Have you made previous application to Mountain View Mushroom Farms?*
YesNo

Are you on a layoff or subject to recall with another employer?*
YesNo

If Yes, what company? When will recall rights cease?

Have you been convicted of a crime which has not been annulled, expunged, eradicated or
sealed by a court?*
YesNo

Have you ever been reprimanded or disciplined by a previous employer for violations of work
or safety rules?*
YesNo

Have you ever been discharged by a previous employer?*
YesNo

If you answered yes to any of the last three questions above, please explain:

Are you available for full time work?*
YesNo

Are you interested in temporary employment?*
YesNo

Are you willing to work over 8 hours a day if the job requires it?*
YesNo

Mountain View Mushrooms operates day and night shifts, seven days a week. Are you
available for work any time?*
YesNo

Include information relative to change of name, nickname, and assumed name, to enable a
check on your work.

Other Information

To assist us in further evaluating your qualifications for a position at Mountain View Mushroom Farms, the additional space provided below is for your use in explaining your response to previously asked questions and in describing your job related capabilities and career interests.

I hereby certify that the information contained in this application is true to the best of my knowledge, and agree to have any of the statements checked by Mountain View Mushrooms unless I have indicated to the contrary.