Application — VALLEY FOODS

Valley Foods Systems
335 East Boardman Street
Youngstown, Ohio 44503

Phone: 800.228.4053
Fax: 330.746.7016
Email: info@valleyfoodsystems.com

Please carefully read and answer all questions. You will not be considered for employment if you fail to completely answer all the questions on this application.

Personal Data

Name

First Name

Last Name

Date of Birth

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Date you can start work

YYYY

Employment Desired

Do you have a high school diploma or GED?

Do you have transportation?

Are you currently employed?

If currently employed, where and what position?

Have you ever been convicted of a felony?

If yes, explain

Have you ever served in the military?

If yes, list service and highest rank

Education

Please list any education or training you feel may be related to the position applied for that would help you perform the work such as schools, colleges degrees, vocational or technical programs and military training.

High School

College

Trade School

Other

Special Skills

List any special skills or experiences that you feel would help you in the position that you are applying for.

Work History

Please start with your most recent employment.

Job #1 Company Name

Supervisors Name

First Name

Last Name

Start Date

YYYY

End Date

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Job Title

Duties Performed

Reason for Leaving

Starting Salary

Ending Salary

Work History Continued:

Job #2 Company Name

Supervisors Name

First Name

Last Name

Start Date

YYYY

End Date

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Job Title

Duties Performed

Reason for Leaving

Starting Salary

Ending Salary

Work History Continued:

Job #3 Company Name

Supervisors Name

First Name

Last Name

Start Date

YYYY

Start Date

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Job Title

Duties Performed

Reason for Leaving

Starting Salary

Ending Salary

Certification

I certify that the facts on this application for employment are true and complete to the best of my knowledge. I understand that if I am employed; false statements, omissions or misrepresentations may result in my dismissal. I authorize Valley Foods to make an inquiry of any of the facts on this application and release the Valley Foods from any liability. Valley Foods may contact any listed references on this application.

Applicant Signature

Date

YYYY