Neesvig's Food Service

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Employment Form

We appreciate your interest in our organization and assure you that your application and qualifications will be given full consideration. Neesvig’s, Inc. is an equal opportunity employer and does not discriminate on the basis of age, race, creed, color, disability, marital status, sex, sexual orientation, religion, national origin, ancestry, arrest or conviction record, veteran status or any other basis prohibited by state or federal law. All pages of this application must be completed in order for the application to be considered.

* Required Information

Pre-Employment Information

What position are you applying for?*

Hours Available:*

Were you previously employed by us?*

Yes

If yes, when?

On what date would you be available for work?*

Employment History

Employer 1

Employer 1:

Employer 1 Telephone:

Employer 1 Address:

Employer 1 City:

Employer 1 State:

Employer 1 Zip Code:

1) Job Title

1) Job Duties:

1) Starting Hourly Rate / Salary:

1a) per

1) Final Hourly Rate / Salary:

1b) per

1) Reason for Leaving:

1) Employed From:

1) to

1) Name of Supervisor and Title:

1) Supervisor Email Address:

1) May we contact for reference? *

Yes

Employer 2

Employer 2:

Employer 2 Telephone:

Employer 2 Address:

Employer 2 City:

Employer 2 State:

Employer 2 Zip Code:

2) Job Title

2) Job Duties:

2) Starting Hourly Rate / Salary:

2a) per

2) Final Hourly Rate / Salary:

2b) per

2) Reason for Leaving:

2) Employed From:

2) to:

2) Name of Supervisor and Title:

2) Supervisor Email Address:

2) May we contact for reference? *

Yes

Employer 3

Employer 3:

Employer 3 Telephone:

Employer 3 Address:

Employer 3 City:

Employer 3 State:

Employer 3 Zip Code:

3) Job Title

3) Job Duties:

3) Starting Hourly Rate / Salary:

3a) per

3) Final Hourly Rate / Salary:

3b) per

3) Reason for Leaving:

3) Employed From:

3) to:

3) Name of Supervisor and Title:

3) Supervisor Email Address:

3) May we contact for reference? *

Yes

Skills & Qualifications

Please provide a summary of why you feel you are qualified for this position:*

Education

School 1

1) Type of School:

1) Name of School:

1) Address:

1) City:

1) State:

1) Zip Code:

1) Course of Study

1) Diploma Received?*

Yes

1) Certificate/Diploma or Degree Received:

School 2

2) Type of School:

2) Name of School:

2) Address:

2) City:

2) State:

2) Zip Code:

2) Course of Study

2) Diploma Received?*

Yes

2) Certificate/Diploma or Degree Received:

School 3

3) Type of School:

3) Name of School:

3) Address:

3) City:

3) State:

3) Zip Code:

3) Course of Study

3) Diploma Received?*

Yes

3) Certificate/Diploma or Degree Received:

References

List three professional references.

Reference 1

1) Name:*

1) Title:*

1) Relationship:*

1) Phone:*

1) Years Known:*

1) Email:

Reference 2

2) Name:*

2) Title:*

2) Relationship:*

2) Phone:*

2) Years Known:*

2) Email:

Reference 3

3) Name:*

3) Title:*

3) Relationship:*

3) Phone:*

3) Years Known:*

3) Email:

Certification and Agreement

I certify that the information provided by me on this application is true and correct without misrepresentation or omission of any kind whatsoever and I understand that if any of this information is discovered to be incorrect, false or misleading, may result in denial of employment or discharge. I authorize the persons, employers, schools and organizations listed above to give any information to Neesvig's, Inc. regarding me for the purpose of performing background checks. I hereby release those employers, schools and organizations and all individuals connected with them from all liability including any claims for damages for releasing this information to Neesvig's, Inc.

By signing this application, I understand that no contract exists between Neesvig's, Inc. and myself. I understand that if I become employed, I am not guaranteed employment and will be considered an employee at will under the laws of the State of Wisconsin.

I have read, understand, and agreed to the above.

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