WAREHOUSE & FULFILLMENT APPLICATION NAME * First Name Last Name ADDRESS * Address 1 Address 2 City State/Province Zip/Postal Code Country EMAIL * PHONE * (###) ### #### HOW DID YOU HEAR ABOUT THIS POSITION? * WHAT DAYS ARE YOU AVAILABLE FOR WORK? * Sunday Monday Tuesday Wednesday Thursday Friday Saturday WHAT HOURS/SHIFTS ARE YOU AVAILABLE FOR WORK? * Day Shift Night Shift IF NEEDED, ARE YOU AVAILABLE TO WORK OVERTIME? * Yes No ON WHAT DATE CAN YOU START WORKING IF YOU ARE HIRED? * MM DD YYYY DO YOU HAVE RELIABLE TRANSPORTATION TO AND FROM WORK? * Yes No HAVE YOU EVER APPLIED TO OR WORKED FOR BARHYTE SPECIALTY FOODS BEFORE? * Yes No DO YOU HAVE FRIENDS, RELATIVES OR ACQUAINTANCES WORKING FOR BARHYTE SPECIALTY FOODS? * Yes No ARE YOU 18 YEARS OF AGE OR OLDER? * Yes No ARE YOU A U.S. CITIZEN OR APPROVED TO WORK IN THE UNITED STATES? * Yes No WHAT DOCUMENTATION CAN YOU PROVIDE AS PROOF OF CITIZENSHIP OR LEGAL STATUS? * WILL YOU CONSENT TO A MANDATORY CONTROLLED SUBSTANCE TEST INCLUDING MARIJUANA? * Yes No DO YOU HAVE ANY CONDITION WHICH WOULD REQUIRE JOB ACCOMMODATION? * Yes No NOTE: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered. LIST THE SKILLS AND QUALIFICATIONS YOU POSSESS FOR THE POSITION FOR WHICH YOU ARE APPLYING. * NOTE: Barhyte Specialty Foods complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/ability and may be subject to a medical examination conducted by a medical professional. HIGH SCHOOL (NAME, CITY, STATE, YEAR GRADUATED) * COLLEGE/UNIVERSITY (NAME, CITY, STATE, YEAR GRADUATED) VOCATIONAL SCHOOL/SPECIALTY TRAINING (NAME, CITY, STATE, YEAR GRADUATED) ARE YOU A MEMBER OF THE ARMED SERVICES? * Yes No MOST RECENT EMPLOYER EMPLOYER NAME * JOB TITLE * SUPERVISOR NAME * EMPLOYER ADDRESS * Address 1 Address 2 City State/Province Zip/Postal Code Country START DATE * MM DD YYYY END DATE * MM DD YYYY EMPLOYER PHONE * (###) ### #### REASON FOR LEAVING * PREVIOUS EMPLOYER EMPLOYER NAME JOB TITLE SUPERVISOR NAME EMPLOYER ADDRESS Address 1 Address 2 City State/Province Zip/Postal Code Country START DATE MM DD YYYY END DATE MM DD YYYY EMPLOYER PHONE (###) ### #### REASON FOR LEAVING REFERENCE #1 NAME * RELATIONSHIP * PHONE * (###) ### #### EMAIL * REFERENCE #2 NAME * RELATIONSHIP * PHONE * (###) ### #### EMAIL * REFERENCE #3 NAME * RELATIONSHIP * PHONE * (###) ### #### EMAIL * AT-WILL EMPLOYMENT: The relationship between you and Barhyte Specialty Foods is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or Barhyte Specialty Foods. No representative of Barhyte Specialty Foods has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and our Chief Operations Officer. WILL YOU CONSENT TO A FULL BACKGROUND SCREENING? * Yes No I certify that to the best of my knowledge the information contained in this application is correct. I understand that falsification of application information or material omission may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I understand and agree to the following: 1. My prior employers, educational instituations and other references listed or not listed on this application are authoirzed to give Barhyte Specialty Foods any and all information concerning my previous employment and any pertinent information they may have. I release all persons listed or not listed or entities from all liability for any damage that may result from furnishing information to Barhyte Specialty Foods. I also release the Company and all of its employees from all liability for any damage that may result from the Company's reliance on the information furnished. 2. I must produce applicable documents showing that I am lawfully authorized to work in the United States, within the time frame specified by the Company, to meet the Immigration Reform and Control Act of 1986 and amended requirements. 3. The cost of any and all company issued equipment not returned upon termination of employment will be billed to you, as the employee. (Bump caps, time cards, gloves, etc.) 4. Barhyte Specialty Foods will not tolerate the abuse of drugs or alcohol in the workplace. Job applicants may be required to pass a pre-employment drug test as a condition of employment. Any employee found to be in possession of illegal drugs or to be under the influence of illegal drugs or alcohol will be subject to termination. Refusal to submit to drug testing may result in disciplinary action, up to and including termination. I agree to submit to drug and alcohol testing upon the reasonable suspicion of the abuse of such substances. If I fail to comply with any of the requirements set forth above, I understand that an offer of employment will be rescinded or my employment will be terminated. In consideration of my employment, I agree to conform to all the Company's policies, rules, and regulations. I understand and agree that my employment with Barhyte Specialty Foods is voluntarily entered into and I am free to resign at any time. Similarly, Barhyte Specialty Foods being an at-will employer, is free to conclude the employment relationship at any time in which the Company believes is in the Company's best interest. I further understand and agree that this at-will relationship as defined above will remain in effect throughout my employment with Barhyte Specialty Foods. ENTER YOUR FULL NAME TO AGREE * AGREEMENT DATE * MM DD YYYY I hereby authorize my past employers to release information to Barhyte Specialty Foods regarding my employment. This release of information covers my employment record in general, including information on the following questions: 1. Dates of employment; 2. Position(s) held; 3. The quality and quantity of my work; 4. My attendance habits (excluding workers' compensation, pregnancy, disability FMLA and other protected absences); 5. My relationship with co-workers, supervisors and managers; 6. My attitude toward work (cooperative? positive? etc.); 7. Reason for leaving and eligibility for rehire (would the employer rehire if they had to do it all over again?); 8. Strong and weak points; 9. Willingness to comply with policies and standards; 10. Whether I have had outbursts of temper, threatened, provoked fights with or assaulted others, engaging in hostile or violent behavior; 11. Other relevant information regarding my performance, skills, ability, suitability for employment sought, etc. I agree that all former employers who provide such information are indemnified and released from liability arising from such disclosures. I also understand that if I do not agree to this Authorization, my application will be rejected. ENTER YOUR FULL NAME TO AGREE * AGREEMENT DATE * MM DD YYYY Thank you!
