Employment Application

Job Preference

Type of Employment:
Available Start Date:	Work Through Date:
Select First Job Preference:	If 'other', please specify:
Select Second Job Preference:	If 'other', please specify:

Personal Information

Last Name	First Name	Initial
Address
City	State or Province	Postal Code
Phone Number	Email Address

Employment Data

Are you 18 years of age or older?	Yes No
Social Security Number
If hired, can you furnish proof that you are eligible to work legally in the U.S.?	Yes No
Were you ever employed at Granby Ranch?	Yes No
If yes, when?
Do you have relatives who work for Granby Ranch?	Yes No
If 'yes', state name(s) and relationship(s):
Have you ever been convicted of any law violation, excluding minor traffic violation?	Yes No
If yes, please provide a brief detail:
How were you referred to Granby Ranch?
When is the best time for us to contact you?

Education

High School	Date Completed /	Highest Grade Completed
College	Date Completed /	Degree / Subjects Studied
Vocational or Technical	Date Completed /	Degree / Subjects Studied
Additional training related to the job which you are applying?		Description
What machines or equipment can you operate that are related to the job which you are applying?		Description
Indicate any foreign languages you speak	How well?
Describe any other courses, training, apprenticeships or educational programs you have taken:

Work Experience

Company Name and Address		Name of Supervisor and Phone Number
Job Title	Last Salary	Reason for leaving
Dates of Employment:	Start /	End /
Briefly describe your work responsibilities:

Company Name and Address		Name of Supervisor and Phone Number
Job Title	Last Salary	Reason for leaving
Dates of Employment:	Start /	End /
Briefly describe your work responsibilities:

Company Name and Address		Name of Supervisor and Phone Number
Job Title	Last Salary	Reason for leaving
Dates of Employment:	Start /	End /
Briefly describe your work responsibilities:

Is there information relative to change of name, nicknames, or assumed names that we may need to check your work record?
Are you presently employed?	Yes No
May we contact your present employer?	Yes No

Other Experience/Skills

List other skills, qualifications or volunteer experience you have that would relate to your application for employment. For example, typing speed, computer experience, equipment you have operated, etc:

Personal References

Please provide 3 references, for example: teachers, pastors or coaches, Do not include relatives or former employers. Include name, address, work relationship and telephone number. May we contact your references? Yes No
Name and Address	Phone Number	Occupation
Name and Address	Phone Number	Occupation
Name and Address	Phone Number	Occupation

An Equal Opportunity Employer

We do not discriminate on the basis of race, religion, national orgin, color, sex, age, veteran status or disability. It is our intention that all applicants be given equal opportunity and that selection decisions are based on job-related factors.

Authorization

I authorize investigation of all statements contained in this Application. I understand that any misleading or incorrect statements will render this Application void, and if employed, I would be subject to termination. I further agree that the Company shall not be liable in any respect if my employment is terminated because of falsity of statements, answers, or omissions made by me in this Application.

I authorize the investigation of all matters contained in this Application and hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, law enforcement agencies, motor vehicle record and others, including conducting a criminal background check, and hereby release the Company from any liability as a result of such contact.

I authorize the Company to conduct a credit check from a consumer-reporting agency as part of their routine processing of this Employment Application.

I have read, understand, and agree, by my submission of this application form, I consent to these statements.

If you are chosen for an interview and need a reasonable accommodation in accordance with American With Disablities Act, please inform us at the time an interview is scheduled.

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