Employment Application

Name*
First Middle Last
Social Security No.*
Present Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Are you at least 18 years of age?*
- Yes
- No
Date of Birth*
MM slash DD slash YYYY
How did you hear about our employment opportunities?*
- Active Employee Referral
- Inactive Employee Referral
- Newspaper Ad
- NCWorks
- Job Fair
- Radio Ad
- Company Website
Employee Name*
Are you legally eligible for employment in the United States?*
- Yes
- No
If offered employment, you will be required to provide documentation to verify eligibility.
Job applied for*
Which shift do you prefer?*
Have you worked with us before?*
- Yes
- No
If yes, when?*
If hired, on what date will you be available to start?*
MM slash DD slash YYYY
Are there any experiences, skills, or qualifications you feel would especially fit you for work with the Company?
- Forklift operator experience
- Bilingual English/Spanish
- Computer Skills
- Commercial Driver’s License
- Machine Operator Experience
- Quality Control / Food Science
Have you ever been convicted of a crime other than a minor traffic offense?*
- Yes
- No
If yes, please explain:*
A conviction will not automatically disqualify you for employment. Rather, such factors as age and date of conviction, seriousness and nature of the crime, and rehabilitation will be considered. Do not include sealed or expunged convictions.

Voluntary Self-Identification of Disability
Form CC-305 : OMB Control Number 1250-0005 : Expires 1/31/2020

Why are you being asked to complete this form?
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.
If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.
How do I know if I have a disability?
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.
Disabilities include, but are not limited to:
- Blindness
- Deafness
- Cancer
- Diabetes
- Epilepsy
- Autism
- Cerebral palsy
- HIV/AIDS
- Schizophrenia
- Muscular dystrophy
- Bipolar disorder
- Major depression
- Multiple sclerosis (MS)
- Missing limbs or partially missing limbs
- Post-traumatic stress disorder (PTSD)
- Obsessive compulsive disorder
- Impairments requiring the use of a wheelchair
- Intellectual disability (previously called mental retardation)
Please select one of the options below:*
- YES, I HAVE A DISABILITY (or previously had a disability)
- NO, I DON’T HAVE A DISABILITY
- I DON’T WISH TO ANSWER
Name*
First Last
Reasonable Accommodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment. *Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp. PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

Military Record
Have you ever served in the armed forces?*
- Yes
- No
If yes, what branch?*
Date of Duty From:*
MM slash DD slash YYYY
Date of Duty To:*
MM slash DD slash YYYY
Rank at discharge*
Voluntary Veteran Status Self ID
Name*
First Middle Last
This employer is a Government contractor subject to the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows:
DISABLED VETERAN
(1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs, or (2) A person who was discharged or released from active duty because of a service‐oriented disability.
RECENTLY SEPARATED VETERAN
Any veteran during the three‐year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval or air service.
ACTIVE DUTY WARTIME OR CAMPAIGN BADGE VETERAN
A veteran who served on active duty in the U.S. military, ground, naval or air service on active duty during a war, or in a campaign or expedition for which a campaign badge has been authorized, under the laws administered by the Department of Defense.
ARMED FORCES SERVICE MEDAL VETERAN
Any veteran who while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operations to which an Armed Forces service medal was awarded pursuant to Executive Order 12985(61 FR 1209)
Protected veterans may have additional rights under USERRA ‐ the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor’s Veterans Employment and Training Service (VETS), toll‐free, at 1‐866‐4‐USA‐DOL.
If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below.
As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.
Please select one:*
- I IDENTIFY AS ONE OR MORE OF THE CLASSIFICATIONS OF PROTECTED VETERAN LISTED ABOVE
- I AM NOT A PROTECTED VETERAN
- I CHOOSE NOT TO SELF‐IDENTIFY
Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended.

Professional/Personal Reference #1
Name
First Last
Phone
Email
Address
City State / Province / Region
Relationship
Professional/Personal Reference #2
Name
First Last
Phone
Email
Address
City State / Province / Region
Relationship
Professional/Personal Reference #3
Name
First Last
Phone
Email
Address
City State / Province / Region
Relationship

Levels of Education Attended*
- Elementary
- High
- College/University
Elementary
School Name*
Address*
City State / Province / Region
Years Completed (1-8)*
Please enter a number from 1 to 8.
High
School Name*
Address*
City State / Province / Region
Years Completed*
College/University
School Name*
Address*
City State / Province / Region
Years Completed*
List degree(s) obtained. Describe specialized training.*

Begin with your most recent employment and continue with all past employment
May we contact your present Employer?*
- Yes
- No
- I'm not currently employed
Past Number of Employers*
Employer #1
Employer
Date From:
MM slash DD slash YYYY
Date To:
MM slash DD slash YYYY
Address*
City State / Province / Region
Phone
Job Held
Your Duties
Supervisor's Name*
First Last
Specific Reason for Leaving*
Starting Pay*
Ending Pay*
Employer #2
Employer
Date From:
MM slash DD slash YYYY
Date To:
MM slash DD slash YYYY
Address*
City State / Province / Region
Phone
Job Held
Your Duties
Supervisor's Name*
First Last
Specific Reason for Leaving*
Starting Pay*
Ending Pay*
Employer #3
Employer
Date From:
MM slash DD slash YYYY
Date To:
MM slash DD slash YYYY
Address*
City State / Province / Region
Phone
Job Held
Your Duties
Supervisor's Name*
First Last
Specific Reason for Leaving*
Starting Pay*
Ending Pay*

Applicant’s Certification and Agreement
Should you need assistance at any stage of the hiring process or would like to discuss potential accommodations related to applying for employment at Mt. Olive Pickle Company, please contact us immediately. Your request for an accommodation will be kept confidential and will only be shared with individuals with a business need-to-know and will not subject you to any adverse treatment.
I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge.
I authorize all schools which I attended and all previous employers to furnish to Mt. Olive Pickle Company, Inc. my record, reason for leaving, and all information they may have concerning me, and hereby release them and Mt. Olive Pickle Company, Inc. from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information.
I authorize my neighbors, friends or other with whom I am acquainted or who are acquainted with me to furnish Mt. Olive Pickle Company, Inc. with information used in connection with the evaluation of my qualifications as a prospective employee. I release such persons and organizations from any legal liability in making such statements.
I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal.
I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules, and regulations of employment of the Employer. However, I further understand that neither the policies, rules, and regulations of employment or anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration an at will and that either I or the Employer may terminate my employment at any time with or without notice or cause.
I acknowledge that I have read and understand the above statements.
*
- I acknowledge that I have read and understand the above statements.
Signature*
Name*
First Last
Upload Resume & Cover Letter*
Max. file size: 10 MB.
Name
This field is for validation purposes and should be left unchanged.

Step 1 of 8 - Personal

Voluntary Self - Identification of EEO Status

Voluntary Self-Identification of Disability

Form CC-305 : OMB Control Number 1250-0005 : Expires 1/31/2020

Why are you being asked to complete this form?

How do I know if I have a disability?

Reasonable Accommodation Notice

Military Record

Voluntary Veteran Status Self ID

Professional/Personal Reference #1

Professional/Personal Reference #2

Professional/Personal Reference #3

Elementary

High

College/University

Employer #1

Employer #2

Employer #3

Applicant’s Certification and Agreement