Employment Application

Education
Education is criterion that the company may utilize in determining whether or not an applicant is qualified.
School #1
Name of school
City State
Grade completed
Did you graduate?
Major
School #2
Name of school
City State
Grade completed
Did you graduate?
Major
School #3
Name of school
City State
Grade completed
Did you graduate?
Major

Work Experience
Please account for all periods of employment. Start with your most recent position and include military service.
Past Employer #1
Company name
City State
Supervisor name and telephone
Ok to contact?
Employment Dates – Start to End
Job title
Starting pay rate to ending pay rate
Reason for leaving
Past Employer #2
Company name
City State
Supervisor name and telephone
Ok to contact?
Employment Dates – Start to End
Job title
Starting pay rate to ending pay rate
Reason for leaving
Past Employer #3
Company name
City State
Supervisor name and telephone
Ok to contact?
Employment Dates – Start to End
Job title
Starting pay rate to ending pay rate
Reason for leaving
Past Employer #4
Company name
City State
Supervisor name and telephone
Ok to contact?
Employment Dates – Start to End
Job title
Starting pay rate to ending pay rate
Reason for leaving
Past Employer #5
Company name
City State
Supervisor name and telephone
Ok to contact?
Employment Dates – Start to End
Job title
Starting pay rate to ending pay rate
Reason for leaving

Business References
Reference #1
Name
First Last
Phone
Occupation
Years known
Reference #2
Name
First Last
Phone
Occupation
Years known
Reference #3
Name
First Last
Phone
Occupation
Years know

Please read carefully before agreeing
I affirm that the information provided is true and complete and that I have not withheld any fact(s). Any misrepresentation, falsification, omission or derogatory information that is discovered may prevent my being hired, or if hired, may subject me to disciplinary action, up to and including immediate employment dismissal.

I authorize Legacy Seeds, Inc. or its agents to conduct an investigation and verification of all statements and information contained in this application that they may deem relevant to evaluating my qualification for employment. I authorize all my previous employers or other persons having information concerning me or my record of employment to report such information. I release each such person, employer or its agents from all claims and liability whatsoever arising out of such an investigation and disclosure of my background.

I understand that the company to which I am applying for employment will seek to keep all such information confidential except where such information is required to be released by law.

Upon receiving a conditional offer of employment by this company, if requested, I agree to submit to a physical examination and/or testing for illegal drugs by a doctor or facility designated by and at the expense of the company. I also agree to submit to testing for alcohol and/or illegal drugs if requested at subsequent intervals as the company may direct during the course of my employment. I understand that refusal to submit to such testing may result in my dismissal. I agree to permit collection of urine, blood, saliva, hair and/or other samples from me to conduct this testing to determine the presence or use of alcohol and/or drugs. Further, I agree to the release of drug test results and other relevant medical information to authorized representatives of the company. I also understand that my employment is contingent upon passing such testing.

I understand that this is an application for employment and that no employment contract is being offered. I also understand that, if offered employment, I will be an at-will employee which means that my employment can be terminated at any time for any reason, with or without notice, at the option of either the company or myself, and that no representative of the company has any authority to make any representation to the contrary.
I have read, understand and agree to the above.*
- I agree

Step 1 of 5

What is your contact information?

Education

School #1

School #2

School #3

Work Experience

Past Employer #1

Past Employer #2

Past Employer #3

Past Employer #4

Past Employer #5

Business References

Reference #1

Reference #2

Reference #3

Please read carefully before agreeing

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