Name
Date
Telephone
Address
Email Address
High School
No. Yrs Attended
Graduate YesNo
College
Special Training
1. Employer
Supervisor
Duties Performed
Dates Employed
From
To
Hourly Rate
Start
Final
Reason for Leaving
2. Employer
3. Employer
1-
2-
3-
Have you ever been employed by Three Chimneys Farm?
YesNo
Have you previously applied for employment with Three Chimneys Farm?
Are you legally eligible and can you provide proof of eligibility to work in the U.S.?
Do you use any illegal drugs?
Have you been convicted of a crime in the past ten years, excluding misdemeanors and summary offenses, which have not been annulled or otherwise erased by the court?
If Yes, please describe in Full
On what date are you available to begin work?
Are you available: Part Time YesNo
Full Time YesNo
Temporary/Seasonal YesNo
Pay Expected:
Type of Work:
Broodmares YesNo
Maintenance YesNo
Yearlings YesNo
Stallions YesNo
Other
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. By my signature below, I authorize Three Chimneys Farm to check the references listed above, unless otherwise stated in writing and to conduct a background check an drug screening upon the offer of employment"
Applicant's Name
