Application for Summer Employment

First Name

Last Name

Your Mailing Address

Town

Postal Code

Home Phone

Cell Phone

Check the box if YES

I am 14 years old as of January 1 this year

Do you have a driver's license?

YES NO

References

Please supply the name and contact information of one reference who is NOT A RELATIVE. By providing this information you are giving us permission to contact the individual.

Name of Reference

Reference Phone

Connection to you:

Work/Volunteer Experience

Company/Organization

Dates Employed (from...until)

Position/Title

Duties/Responsibilities

Reason for Leaving

Name of Supervisor

Phone number

In a paragraph or two, tell us why we should consider hiring you at Miller's Bay Farm

Area(s) of Interest (check all that apply)

Berry Picking (early hours) Other picking/packaging Customer Service

Disclaimer

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I understand the hours and commitment involved.

Acceptance

Check here if you accept these term

Your typed name will be considered to be your signature

Date of application

Application for Summer Employment

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