Employment Application

Please print, complete, and mail this application to:

Harman's Produce, LLC: Employment Application

320 Priestford Rd.

Churchville, MD 21028

Application For Employment

1. Today's date: _____________________

2. Name: ______________________________________________________________________________

3. Address: _____________________________________________________________________________

Street City, State Zipcode

4. Telephone Number: HOME: _________________________________________

WORK: _________________________________________

5. Social Security number: _____________________________

6. How did you hear about Harman's Farm? ________________________________________________

7. Work desired:

a. list the position for which you are applying_____________________________________________

b. Minimum hourly wage required: ____________________________________

c. Date available for work: __________________________________________

8. Are you a licensed driver? YES ________ NO ___________

9. Qualifications: Describe your previous work experience, knowledge, and skills that you feel

qualify you for this work: ___________________________________________________________________

________________________________________________________________________________________

10. Do you have any physical limitations that would hinder or limit your capacity to perform farm

work? YES ____ NO _____

If yes, please describe: ______________________________________________________________________

__________________________________________________________________________________________

11. Education:

Name of School Degree earned and when

____________________________________________________________________________________________

12. During the last seven years, have you been convicted of a misdemeanor or of a felony or

convicted in a military court martial? YES ____ NO ____

If yes, state the dates and circumstances involved: _________________________________________________

____________________________________________________________________________________________

13. Employment History: List your last three employers below:

a. Employer's name, address, and telephone no.:____________________________________________________

__________________________________________________________________________________________

Employed From - To: ____________________________________________________________

Salary Start - End: ______________________________________________________________

Describe your duties: ____________________________________________________________

_______________________________________________________________________________

Reasons for leaving: _____________________________________________________________

_______________________________________________________________________________

b. Employer's name, address, and telephone no.: ________________________________________

_______________________________________________________________________________

Employed From - To: ____________________________________________________________

Salary Start - End: ______________________________________________________________

Describe your duties: ____________________________________________________________

______________________________________________________________________________

Reasons for leaving: _____________________________________________________________

______________________________________________________________________________

c. Employer's name, address, and telephone no.: ________________________________________

_______________________________________________________________________________

Employed From - To: ______________________________________________________________

Salary Start - End: _______________________________________________________________

Describe your duties: ____________________________________________________________

_______________________________________________________________________________

Reasons for leaving: _____________________________________________________________

______________________________________________________________________________

14. Personal References: List 3 references (other than immediate family members) with addresses and telephone numbers:

______________________________________________________________________________

_______________________________________________________________________________

15. In case of emergency, notify:

Name: ________________________________________________________

Address: _______________________________________________________________________

Telephone: Work: _________________________________________________

Home: _________________________________________________

Cell Phone: _____________________________________________

Read and Sign Below

The facts set forth in the Application for Employment are true and complete. I understand that, if employed, false statements on this application shall be considered sufficient cause for dismissal. Harman's Produce, LLC (Harman's Farm), is hereby authorized to make any investigation of my personal history, employment references or history, and/or credit record through an investigative or credit agency or bureau of your choice. I further agree that, if hired, my employment is for a definite duration and either the Company or I may terminate our relationship at will, without notice, and with or without reason.

_________________________________________________________________________

Signature Date

Please do not e-mail this application as signatures are required.