I have read & understood the Statement of Values of Rosemary and Vine: *

Yes

First & Last Name *

First & Last Name

First Name

Last Name

Phone *

Phone

(###)

###

####

Address: *

Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email *

Rosemary and Vine is an equal opportunity employer and does not discriminate against any applicant or employee because of race, color, religion, sex, national origin, disability, age, or military or veteran status in accordance with federal law. In addition, Rosemary and Vine complies with applicable state and local laws governing nondiscrimination in employment in every jurisdiction in which it maintains facilities. Rosemary and Vine also provides reasonable accommodation to qualified individuals with disabilities in accordance with applicable laws.

Are you interested in: *

Full time

Part time

Temporary

How many shift per week are you interested in?

What schedules would you prefer? *

Weekdays

Weekends

Mornings

Evenings

How did you hear about us? *

Have you worked for this company before? *

If Yes, under what name & what dates?

Do you know anyone who works here? *

Desired hourly pay:

Desired weekly pay net of taxes:

When are you able to start work? *

When are you able to start work?

YYYY

Position desired: *

Are you authorized to work in the United States? *

Federal law requires that employers hire only individuals who are authorized to be lawfully employed in the United States. In compliance with these laws, Rosemary and Vine will verify the status of every individual offered employment with the company. In this connection, all offers of employment are subject to verification of the applicant's identity and employment authorization, and it will be necessary for you to submit such documents as required by law to verify your identification & employment authorization.

Are you under 18 years of age? *

If yes, can you furnish a work permit?

List any special skills or training

LIST YOUR WORK EXPERIENCE BELOW:

Most recent job first

Company name:

Your position & title:

Address of the company:

Type of business:

Supervisor's name

Supervisor's phone number

From: Month/Year

To: Month/Year

Termination:

Reason for termination:

Briefly describe your MAJOR DUTIES:

Company Name:

Your position & title:

Address of the company:

Type of business:

Supervisor's name:

Supervisor's phone number

From: Month/Year

To: Month/Year

Termination:

Reason for termination:

Briefly describe your MAJOR DUTIES:

Company Name:

Your position & title:

Address of the company:

Type of business:

Supervisor's name

Supervisor's phone number

From: Month/Year

To: Month/Year

Termination:

Reason for termination:

Briefly describe your MAJOR DUTIES:

Education

High school or prep:

Major subject:

Did you graduate?

Type of degree or diploma:

College:

Major subject:

Did you graduate?

If no, when do you expect to graduate?

Type of degree or diploma:

REFERENCES:

Name:

Relationship:

Company:

Phone number:

(###)

###

####

Name:

Relationship:

Company:

Phone number:

(###)

###

####

Name:

Relationship:

Company:

Phone number:

(###)

###

####

PLEASE READ CAREFULLY BEFORE SIGNING APPLICATION I have submitted the attached form to Rosemary and Vine for the purpose of obtaining employment. I acknowledge that the use of this form, and my filling it out, does not indicate that any positions are open, nor does it obligate Rosemary and Vine to further process my application. My signature below attests to the fact that the information that I have provided on my application, resume, given verbally, or provided in any other materials, is true and complete to the best of my knowledge and also constitutes authority to verify any and all information submitted on this application. I understand that any misrepresentation or omission of any fact in my application, resume or any other materials, or during any interviews, can be justification for refusal of employment, or, if employed, termination from Rosemary and Vine employment. I also affirm that I have not signed any kind of restrictive document creating any obligation to any former employer that would restrict my acceptance of employment with Rosemary and Vine in the position I am seeking. I understand that this application is not an employment contract for any specific length of time between Rosemary and Vine and me, and that in the event I am hired, my employment will be “at will” and either Rosemary and Vine or I can terminate my employment with or without cause and with or without notice at any time. Nothing contained in any handbook, manual, policy and the like, distributed by Rosemary and Vine to its employees is intended to or can create an employment contract, an offer of employment or any obligation on Rosemary and Vine's part. Rosemary and Vine may, at its sole discretion, hold in abeyance or revoke, amend or modify, abridge or change any benefit, policy practice, condition or process affecting its employees. References: I hereby authorize Rosemary and Vine and its agents to make such investigations and inquiries into my employment and educational history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, and other persons from all liability in responding to inquires connected with my application and I specifically authorize the release of information by any schools, businesses, individuals, services or other entities listed by me in this form. Furthermore, I authorize Rosemary and Vine and its agents to release any reference information to clients who request such information for purposes of evaluating my credentials and qualifications. *

By checking this box, I acknowledge that I have read and understand all the information contained in this form

Name *

Name

First Name

Last Name

Date *

Date

YYYY