50 Water Street Glen Rock, PA 17327
(717) 235-5918
0
Sign In
View Cart
Cart
About
History
News
Meet the Owner
Simply Local
Tulsi Fields Farm
Christmas in Glen Rock
Menus
Lodging
Events
Calendar
$3 OFF wine at SIP|Social Lounge
Live Piano in the Dining Room
Contact
Employment
Reservations
Gift Cards
Employment Application
Position(s) applied for
*
How did you find out about this job?
*
Social Media
Employee
Walkin
Relative
Other
Why are you seeking a new job at this time?
*
Applicant Information
Name
*
First
Middle
Last
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Social Security No.
*
Phone
*
Email
*
If hired, do you have a reliable means of transportation to get to work?
*
Yes
No
Sometimes
Are you 16 years or older?
*
Yes
No
Are you at least 18 years old?
*
Yes
No
Becuase you are under 18 years of age, can you furnish a work permit?
*
Yes
No
If the job you are applying for requires driving: Driver’s License No., State, and Expiration Date
Are you legally eligible for employment in the U.S.?
*
Proof of U.S. citizenship or immigration status is required if hired
Yes
No
Have you been convicted of a crime?
*
Massachusetts applicants should not include misdemeanor convictions; California applicants should not include marijuana-related convictions that oc-curred more than 2 years prior to the application date
Yes
No
state the nature of the offense and disposition of the case. Include dates and places.
*
NOTE: The existence of a criminal record does not constitute an automatic bar to employment
Are you a veteran?
*
Yes
No
Please provide dates of service:
*
Please list any special skills or training you may have
Employment Information
Are you seeking full time, part time or temporary employment?
*
Select All
Full time
Part Time
Temporary employment
What hours and shift(s) would you prefer to work?
*
List times you are not available to work?
*
Are you willing to work overtime?
*
Yes
No
It depends
Are you willing to work weekends?
*
Yes
No
It depends
Are you willing to work holidays?
*
Yes
No
It depends
Are you currently employed?
*
Yes
No
If hired, when would you be able to start?
*
MM slash DD slash YYYY
Have you ever worked for this organization before?
*
Yes
No
List any friends or relatives employed by this company:
Have you ever been discharged or asked to resign from any position?
*
Yes
No
If yes, please describe:
Are you able to perform all work tasks with or without reasonable accommodation?
*
With
Without
Please describe which tasks, if any, you will need accommodation to perform, and explain what type of accommodation you will need:
Education
Years of Elementary School completed:
*
0
1
2
3
4
5
6
7
8
Name of School:
Location of School:
Years of High School completed:
*
0
1
2
3
4
Name of School:
Location of School:
Are you enrolled in a recognized co-op program?
Yes
No
If yes, identify program
Years of College completed:
*
0
1
2
3
4
5
6
7
8
Name of School:
Location of School:
Degree & Major:
Minor:
Work History
(please begin with most recent)
How many previous employers have you had?
0
1
2
3
4
Company 1
Company 1 Name
Company 1 Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Company 1 Phone
Company 1 Starting Date
Company 1 Ending Date
Company 1 Salary
Company 1 Job Title
Company 1 Supervisor’s Name & Title
Company 1 Job Duties
Company 1 Reason for Leaving
Company 2
Company 2 Name
Company 2 Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Company 2 Phone
Company 2 Starting Date
Company 2 Ending Date
Company 2 Salary
Company 2 Job Title
Company 2 Supervisor’s Name & Title
Company 2 Job Duties
Company 2 Reason for Leaving
Company 3
Company 3 Name
Company 3 Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Company 3 Phone
Company 3 Starting Date
Company 3 Ending Date
Company 3 Salary
Company 3 Job Title
Company 3 Supervisor’s Name & Title
Company 3 Job Duties
Company 3 Reason for Leaving
Company 4
Company 4 Name
Company 4 Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Company 4 Phone
Company 4 Starting Date
Company 4 Ending Date
Company 4 Salary
Company 4 Job Title
Company 4 Supervisor’s Name & Title
Company 4 Job Duties
Company 4 Reason for Leaving
May we contact the employers listed above?
Yes
No
Authorizations & At-Will Employment Agreement
I certify that I have personally completed this application. I declare that the information provided in this employment application is true and complete and I understand that any false information or significant omissions may disqualify me from further consid-eration for employment and may be justification form my dismissal from employment if discovered at a later date. I agree to im-mediately notify this company if I should be convicted of a crime while my job application is pending or during my employment, if hired. I authorize this company to make an investigation of all information contained in this employment application and I release from liability all companies and corporations supplying such information. I understand any false answers, statements, or implications made by me on this application or other required documents shall be considered sufficient cause for denial of employment or dis-charge. I specifically authorize and direct my current and former employers to supply employment-related information to this company and do hereby release my current and former employers from liability for providing information to this company. Upon termination of my employment for whatever reason, I release this company from all liability for supplying any information concerning my employment to any potential employer. I authorize this company, if applicable, to request a copy of my credit report, motor vehicle driving record, and any other investiga-tive report deemed necessary through various third party sources. As required by law, upon request within a reasonable period of time, I will be notified as to the nature and scope of such investigations. I hereby agree to submit to any drug test required of me, whether prior to my employment or if employed by this company at any time thereafter. If requested, I will take a post-job offer physical examination and my employment, in the event I receive medical treatment for any condition, including a physical, psychological, emotional, or psychiatric condition that is job-related, I hereby authorize the limited release and exchange of such medical information relating to my condition between the treatment provider and a company-designated physician. AT-WILL EMPLOYMENT AGREEMENT I understand and agree that nothing contained in this application, or conveyed during any interview is intended to create an em-ployment contract between the company and me. In addition, I understand and agree that if you employ me, in consideration of my employment, my employment and compensation will be at-will, for no definite period of time, and may be terminated at any time, for any reason, or for no reason at all. I understand that only the company’s President is authorized to change the employ-ment-at-will status and such a change can only be done in writing. I have read, understand, and agree to the above.
Consent
*
I agree to everying above
