Last Name   First Name w/Initial    Today's Date

EMPLOYMENT HISTORY

Please provide a COMPLETE employment history, even if a resume is submitted with this application. List ALL employers starting with the most recent, including military employment. Explain any gaps in employment in the “Comments” section below.

1. Present/Most Recent Employer   From   To

Address: City, State and Zip   Job Title  

Immediate Supervisor and Title    Hourly Rate/Salary Starting $ per      Final $ per

Summarize the nature of the work performed and job responsibilities.

Address: City, State and Zip   Job Title  

Immediate Supervisor and Title    Hourly Rate/Salary Starting $ per      Final $ per

Summarize the nature of the work performed and job responsibilities.

3. Recent Employer   From   To

Address: City, State and Zip   Job Title  

Immediate Supervisor and Title    Hourly Rate/Salary Starting $ per      Final $ per

Summarize the nature of the work performed and job responsibilities.

REFERENCES

List three business/work references who are NOT related to you and are NOT previous supervisors. If not applicable, list three school or personal references not related to you.

Name   Telephone   Years known  

In what capacity did this person observe you or your work?

SPECIAL ACCOMPLISHMENTS, PUBLICATIONS AND AWARDS
Exclude information that would reveal sex, race, religion, national origin, age, color, or disability.

Accomplishments

OTHER INFORMATION
Have you ever been convicted of, or are you now under charges for, any misdemeanor or felony offense? Omit (1) traffic fines, (2) any offense committed before your 18th birthday which was finally adjudicated in a juvenile court or under a youth offender law, (3) any conviction the record of which has been expunged under federal or state law, and (4) any conviction set aside under the Federal Youth Corrections Act or similar authority. (A yes response will not necessarily disqualify you from employment.)

Yes     No     If checked yes, please explain below.

If you have ever been granted a security clearance by any government agency, indicate the level of clearance, when granted, and by whom?

Security Clearance

Have you ever had a security clearance suspended, denied, or revoked?   Yes    No

Are you bound by any non-solicitation/non-compete agreement?   Yes   No

What prompted your application to Habersham Vintners D/B/A?  (Please indicate name of ad/friend)

Ad    Friend   Habersham Vintners Employee

Other

Please review application carefully. We will not consider this application if not completed in full. Please read the following and sign the application in the spaces provided below. If you have any questions, please speak with a manager before signing.

I understand that employment by Habersham Vintners D/B/A and any of its companies is “at will.” This means that the employment relationship can be ended by me or by Habersham Vintners D/B/A at any time for any reason with or without advanced notice and with or without cause. It also means that Habersham Vintners D/B/A may revise and make exceptions to its policies, practices, handbooks, manuals, rules, procedures, and regulations, in whole or in part, at any time.

I further understand that acceptance of an offer of employment does not create a contractual obligation upon Habersham Vintners D/B/A to continue to employ me in the future or for any specific term. If employed by Habersham Vintners D/B/A, I agree to comply with all safety and health rules, company policies and procedures, and local, state, and federal laws pertaining to my employment. Although management makes every effort to accommodate individual preferences, organizational needs may make the following conditions mandatory: overtime, rotating work schedule, or a work schedule other than Monday through Friday or normal business hours.

I understand and accept these as conditions of my employment should I be hired. I have reviewed this application carefully and I hereby affirm that my statements and answers to all questions on this application are true and correct and that I have not knowingly withheld any fact or circumstance that, if disclosed, would affect my application unfavorably. I understand that any misstatement or omission of fact on this application may result in my application not being considered, and, if employed, may result in my immediate dismissal.

I HAVE READ AND AGREE TO THE ABOVE TERMS AND CONDITIONS

Yes    No      Date    Email