Come Grow with Us!

Thanks for your interest in working at Shady Brook Farm! Please submit this application for review. If you meet our qualifications we'll give you a call to schedule an interview. Please note, submission of this application is not guarantee of a job.

Personal Information

First Name *

Last Name *

Address 1 *

How long have you lived here?

City *

State *

Zip Code *

Previous Address

How long did you lived there?

City *

State *

Zip Code *

Phone *

Email Address *

Position Applying For *

Food & Beverage (must be 18)

Special Events

Wagon Ride Driver (must be 18)

Garden Center

Cashier

Uncle Dave's Ice Cream

Beverage Manager (must be over 21 & full time)

Farm Market Event Manager / Bartender (must be over 18 & full time)

Other (please list) Other (please list)

Are you at least 18 years of age? *

Yes

If not, please state your age. *

Can you produce the necessary work certificate at time of employment? *

Yes

In years &/or months, how long are you willing to work here? *

Type of employment desired: *

Part Time

Full Time

How many hours are you willing to work per week? *

Are you willing to work overtime? *

Yes

I understand shifts are anywhere from 3 to 8 hrs. *

Yes

I am available to work weekdays and weekends? *

Yes

I (not my parents) am responsible for myself, my life, and my shifts?

Yes

I am able & willing to work from Sept to Dec? *

Yes

This is a summer job for me and I am available to start (list start & end dates):

Date on which you can start work, if hired: * +

Availability

Shift preference: *

Morning

Afternoon

Evening

No Preference

List other commitments or responsibilities that may interfere with your availability: *

Employment History

Have you previously applied for employment with Shady Brook Farm Markets, Inc.? *

Yes

If yes, when and where did you apply? *

Have you ever been employed by Shady Brook Farm Markets, Inc.? *

Yes

If yes, provide the dates of employment, location, and reason for separation from employment: *

Please list the names of your present and/or previous employers in chronological order with present or last employer listed first. Account for all periods of time, including any period of unemployment. If self-employed, supply firm name and business references. You may include any verifiable work performed on a volunteer basis, internships, or military service. Your failure to completely respond to each inquiry may disqualify you from consideration for employment.

Employer 1

Company Name

Address

Type of Business

Start Date +

End Date +

Job Title

Wage

Reason for Leaving

What will this employer say was the reason your employment terminated?

How much notice did you give when resigning? If none, please explain.

Employer 2

Company Name

Address

Type of Business

Start Date +

End Date +

Job Title

Wage

Reason for Leaving

What will this employer say was the reason your employment terminated?

How much notice did you give when resigning? If none, please explain.

Have you ever been terminated or asked to resign from any job? *

Yes

If yes, how many times?

Has your employment ever been terminated by mutual agreement? *

Yes

If yes, how many times?

Have you ever been given the choice to resign rather than be terminated? *

Yes

If yes, how many times?

If you answered yes to any of the above questions, please explain the circumstances of each occasion.

References

Please list the names of additional work-related references we may contact. Individuals with no prior work experience may list school or volunteer-related references.

Professional Reference 1

Name

Position

Company

Work Relationship (supervisor, co-worker, etc.)

Phone

Professional Reference 2

Name

Position

Company

Work Relationship (supervisor, co-worker, etc.)

Phone

Personal Reference 1

Name

Occupation

Address

Phone

# Years Known

Personal Reference 2

Name

Occupation

Address

Phone

# of Years Known

Additional Info

Describe any hobbies or interests you have:

List all special technical skills that you feel qualify you for the job for which you are applying:

Did anyone refer you?

Education

	School Name & Location
High School	School Name & Location
College	School Name & Location
Other Education	School Name & Location
Life Education	School Name & Location

Education

	Course of Study
High School	Course of Study
College	Course of Study
Other Education	Course of Study
Life Education	Course of Study

Education

	# of Years Completed
High School	# of Years Completed
College	# of Years Completed
Other Education	# of Years Completed
Life Education	# of Years Completed

Education

	Graduate?
High School	Graduate?
College	Graduate?
Other Education	Graduate?
Life Education	Graduate?

Education

	Degree/Major
High School	Degree/Major
College	Degree/Major
Other Education	Degree/Major
Life Education	Degree/Major

Education

	Honors Received
High School	Honors Received
College	Honors Received
Other Education	Honors Received
Life Education	Honors Received

The Company in the following statements is Shady Brook Farm Markets, Inc. operating as Shady Brook Farm. I understand and agree that if driving is a requirement of the job for which I am applying, my employment and/or continued employment is contingent on possessing a valid driver’s license for the state in which I reside and automobile liability insurance in an amount equal to the minimum required by the state where I reside. *

I understand Shady Brook Farm Markets, Inc. may now have, or may establish, a drug-free workplace or drug and/or alcohol testing program consistent with applicable federal, state, and local law. If the company has such a program and I am offered a conditional offer of employment, I understand that if a pre-employment (post-offer) drug and/or alcohol test is positive, the employment offer may be withdrawn. I agree to work under the conditions requiring a drug-free workplace, consistent with applicable federal, state, and local law. I also understand that all employees of the location, pursuant to the company’s policy and general, state, and local law, may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or illegal or controlled drugs. If employed, I understand that the taking of alcohol and/or drug tests is a condition of continual employment and I agree to undergo alcohol and drug testing consistent with the company’s policies and applicable federal, state, and local law. *

If employed by the Shady Brook Farm Markets, Inc., I understand and agree that the company, to the extent permitted by federal, state, and local law, may exercise its right, without prior warning or notice, to conduct investigations of property (including but not limited to, files, lockers, desks, vehicles, and computers) and, in certain circumstances, my personal property *

I understand and agree that as a condition of employment and to the extent permitted by federal, state, and local law, I may be required to sign confidentiality, restrictive covenant, and/or conflict of interest statement, as well as an agreement to arbitrate. *

I certify that all the information on this application, my resume, or any supporting documents I may present during any interview is and will be complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or mission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action, up to and including immediate dismissal. *

SHADY BROOK FARM MARKETS, INC. IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANYTIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE. NOTHING IN THIS APPLICATION OR IN ANY DOCUMENT OR STATEMENT, WRITTEN OR ORAL, SHALL LIMIT THE RIGHT TO TERMINATE EMPLOYMENT AT-WILL. NO OFFICER, EMPLOYEE OR REPRESENTATIVE OF SHADY BROOK FARM MARKETS, INC. IS AUTHORIZED TO ENTER INTO AN AGREEMENT –EXPRESS OR IMPLIED- WITH ME OR ANY APPLICANT FOR EMPLOYMENT FOR A SPECIFIED PERIOD OF TIME UNLESS SUCH AN AGREEMENT IS IN A WRITTEN CONTRACT SIGNED BY THE PRESIDENT OF THE COMPANY. *

IF HIRED, I AGREE TO CONFORM TO THE RULES AND REGULATIONS OF SHADY BROOK FARM MARKETS, INC., AND I UNDERSTAND THAT IT WILL NOT MODIFY ITS POLICY OF EMPLOYMENT AT-WILL. *

I authorize and consent to, without reservation, any party or agency contacted by this employer to furnish the above-mentioned information. I hereby release, discharge, and hold harmless, to the extent permitted by federal, state, and local law, any party delivering information to Shady Brook Farm Markets, Inc. its duly authorized representative pursuant to this authorization from any liability, claims, charges, or causes of action which I may have as a result of delivery or disclosure of the above requested information. I hereby release from liability the Company and its representative for seeking such information and all other persons, corporations, or organizations furnishing such information. *

If hired by Shady Brook Farm Markets, Inc., I understand that I will be required to provide genuine documentation establishing my identity and eligibility to be legally employed in the United States by Shady Brook Farm Markets, Inc. I also understand this Company employs only individuals who are legally eligible to work in the United States. *

THIS APPLICATION WILL BE CONSIDERED ACTIVE FOR A MAXIMUM OF SIXTY (180) DAYS. IF YOU WISH TO BE CONSIDERED FOR EMPLOYMENT AFTER THAT TIME, YOU MUST REAPPLY. *

I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE, ACCURATE, AND COMPLETE. *

Signature *

clear

Date * +

If the applicant is a minor, the foregoing release and consent must be signed by the applicant’s parent or legal guardian. Signature by the applicant’s parent or legal guardian constitutes acknowledgement by the applicant and the parent or legal guardian that Shady Brook Farm Markets, Inc., to the extent permitted by federal, state, and local law, can test the applicant for illegal or controlled substances, conduct inspections of property without notice, and communicate test results to Company personnel who need to know, the applicant, and the applicant’s legal guardian.

Parent/Legal Guardian Signature

clear

Date +

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