This application form is intended for use in evaluating your suitability for employment. It is not an employment contract. Please answer all appropriate questions completely and to the best of your ability. False or misleading statements are grounds for refusal or termination of employment and benefits. We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including age, sex, color, race, creed, national origin, religious persuasion, marital status, political belief, or disability that does not prohibit performance of essential job functions.

Items in the form below that are marked with an asterisk (*) are required.

Last Name* | First Name* | M.I.*
Street Address*
City* | State* | Zip Code*	-- FL GA IL IN KY MA MN NC NJ NY OH PA TN TX WA
Email*
Day Phone* | Eve Phone
Social Security Number*
Position*
Date Available* | Desired Salary
Are you eighteen years of age or older?*	Yes No
	Federal law prohibits the employment of unauthorized aliens. All persons hired must submit proof of employment authorization and identity (valid driver's license, birth certificate, green card, etc.) before they can begin working.
Education*	Please include high school, college and vocational studies, number of years, date of graduation, and major coursework.
Special Skills*	Please include any special training, study or skills

Do you have any objection to working overtime?*	Yes No
Do you require prior notice to work overtime?*	Yes No
Employment History*	List your last four employers starting with the most recent. Please include duration of employment, name and address of employer, salary, position, and reason for leaving.
References*	Please list three personal references. Do not include relatives or former employers. Please include name, phone number, current employer, and number of years you've been acquainted.

An affirmative answer will not necessarily bar the applicant from employment.

Have you ever filed any Workers Compensation claims?*	Yes No
If yes, please explain
Do you have any type of limitation that we will need to accommodate?*	Yes No
If yes, please explain
Have you ever been arrested and convicted of a criminal offense?*	Yes No
If yes, please explain
What languages do you speak fluently?
	Authorization and General Release By clicking the Submit button below, you authorize all corporations, companies, credit agencies, educational institutions, persons, law enforcement agencies, military services and former employers to release information they may have about you to FOOD SYSTEMS UNLIMITED, INC. or its agents and releases them from any liability or responsibility from doing so. Further, you authorize the procurement of an investigative consumer report and understand that such a report may contain information about your background, character and personal reputation. You understand that this notices will also apply to any future update reports that may be requested.