C W TAYLOR FARM, LLC. EMPLOYEE APPLICATION

DATE

PERSONAL INFORMATION: LEGAL NAME

STREET ADDRESS CITY/STATE/ZIP

DATE OF BIRTH M/D/Y CELL PHONE

LEGAL GUARDIAN (if under 18)

SSN

HOME PHONE

EMERGENCY CONTACT

RELATIONSHIP TO APPLICANT HOME PHONE

HEALTH INSURANCE COMPANY

WORK

CELL

POLICY NUMBER

KNOWN ALLERGIES OR HEALTH CONDITIONS

Are you able to lift 50 lbs?

Are you able to work outside in heat/sun n(w/ reasonable breaks for shade & hydration)? EDUCATION INFORMATION:

NAME OF SCHOOL CURRENTLY ATTENDING GRADE/YEAR ENTERING THIS FALL

FUTURE EDUCATION/CAREER GOALS DRIVING INFORMATION:

DO YOU HAVE A VALID DRIVER’S LICENSE (Please provide copy)

C W TAYLOR FARM, LLC. EMPLOYEE APPLICATION

IF YES, HAVE YOU HAD ANY VIOLATIONS IN THE LAST YEAR? Describe. HAVE YOU BEEN INVOLVED IN ANY MOTOR VEHICLE ACCIDENT WHEN YOU WERE DRIVING? Describe. HAVE YOU EVER DRIVEN A TRACTOR?

Where?

HAVE YOU COMPLETEED A TRACTOR SAFETY COURSE?

SCHEDULE & AVAILABILITY: Produce season runs from mid/late-June through mid-September.

LIST EXTRACURRICULAR ACTIVITIES (school/local sports, travel leagues, Scouts, other organizations) DATES OF KNOWN VACATIONS, CAMPS & APPOINTMENTS DURING THE SEASON OTHER INFORMATION:

Can you add and subtract mathematically without using a calculator?

Can you calculate monetary transactions and make change without the use of a cash register? Do you consider yourself to be an honest person?

On a scale of 1 to 10, how honest do you consider yourself to be, with 1 being completely dishonest and 10 being completely honest?

On a scale of 1 to 10, if you saw a fellow employee, including your best friend, stealing from your employer, how likely would you be to report the employee to your employer, with 1 being highly unlikely and 10 being absolutely certain? EXPERIENCE:

LIST ANY PREVIOUS EMPLOYERS, OR ANY JOBS YOU HAVE PERFORMED FOR PAYMENT (i.e. babysitting, yardwork, etc). DESCRIBE JOB DUTIES FOR EACH.

C W TAYLOR FARM, LLC. EMPLOYEE APPLICATION

2 NON-FAMILY REFERENCES

1. NAME RELATIONSHIP TO YOU CONTACT INFO 2. NAME RELATIONSHIP TO YOU CONTACT INFO

HOW DID YOU HEAR ABOUT THIS JOB OPPORTUNITY? DISCLOSURES:

I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information can be the basis for rejection of my application, or termination if I am hired. I understand if I am under the age of 18, I must provide a valid work permit before I am allowed to begin work. I authorize C.W. Taylor Farms, LLC to contact former employers and educational organizations regarding my employment and education. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education. If an employment relationship is created, I understand that this relationship is voluntary in nature. In other words, with appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer, C.W. Taylor Farms, LLC, would have the same right. APPLICANT SIGNATURE NAME DATE

C W TAYLOR FARM, LLC. EMPLOYEE APPLICATION

PARENT/GUARDIAN SIGNATURE (if applicant is under 18) NAME DATE