Employment Application

Personal Information:
Name*
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Are you at least 18 years?*
- Yes
- No
Are you eligible for employment in the U.S.A.?*
- Yes
- No

If the applied-for position's job description requires a driver's license, do you have a current, valid, Oregon Driver's License?
- Yes
- No
- N/A
Have you ever had your driver's license suspended or revoked?
- Yes
- No
- N/A

Employment History: List below last four employers starting with most recent first.
Employer 1
Name and address of employer 1
Phone
From:
Month
Day
Year
To:
Month
Day
Year
Hours per week
Position
Duties
Supervisor
Reason for leaving
May we contact?
- Yes
- No
Employer 2
Name and address of employer 2
Phone
From:
Month
Day
Year
To:
Month
Day
Year
Hours per week
Position
Duties
Supervisor
Reason for leaving
May we contact?
- Yes
- No
Employer 3
Name and address of employer 3
Phone
From:
Month
Day
Year
To:
Month
Day
Year
Hours per week
Position
Duties
Supervisor
Reason for leaving
May we contact?
- Yes
- No
Employer 4
Name and address of employer 4
Phone
From:
Month
Day
Year
To:
Month
Day
Year
Hours per week
Position
Duties
Supervisor
Reason for leaving
May we contact?
- Yes
- No

References: Please provide the names of at least three (3) professional references, with at least one (1) current or former direct supervisor.
Reference 1
Reference 1 Name
First Last
Title/Business
Phone
Years acquainted and relationship to you
Reference 2
Reference 2 Name
First Last
Title/Business
Phone
Years acquainted and relationship to you
Reference 3
Reference 3 Name
First Last
Title/Business
Phone
Years acquainted and relationship to you
Reference 4
Reference 4 Name
First Last
Title/Business
Phone
Years acquainted and relationship to you

Please read the application requirements for this position carefully. Some, but not all, require both this application and a cover letter and or a resume. If a cover letter or resume are required to apply, please upload them here.
Please upload your resume.
Accepted file types: docx, pdf, Max. file size: 50 MB.
Please upload your cover letter.
Accepted file types: docx, pdf, Max. file size: 50 MB.

Information to the applicant:
As part of processing your employment application, your personal and employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. Employment with FOOD For Lane County is at-will. This means your employment is for an indefinite period of time and it is subject to termination by you or FOOD For Lane County, with or without cause, with or without notice, and at any time. FOOD For Lane County is an equal opportunity employer. FOOD for Lane County does not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, other non-merit factor, or any other basis protected in the State of Oregon. All job offers are contingent on a successful background check. If given an offer of employment, you will receive an authorization request to proceed from our third-party nationwide background check provider.
If given a job offer, will you consent to a background check?
- Yes
- No
Signature

I understand and agree to the information shown above. Entering your name on the signature line is accepted as your signature.
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Personal Information: