Linden Hills Co-op - Harvest Moon Co-Op.pdf by tongxiamy

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									Harvest Moon Natural Foods Cooperative, Inc.
2380 Wayzata Boulevard
Long Lake, Minnesota 55356
Phone: 952.345.3300 FAX: 952.345.3303
www.harvestmoon.coop

                                      Employment Application

Name ____________________________________________________________________Date_________

Address ______________________________________________ City _________________ Zip ________

Day Phone (____) ____________ Other Phone (____) ____________ E-Mail _________________________

                                                                                  Example:
Thank you for your interest in Harvest Moon Natural Foods Cooperative,            Ideal number of hours
Inc. Please check off which positions and hours interest you.                     per week:
                                                                                     10     15     20
You should know that:                                                                30     40
   • Employees work at least one weekend day per week                             Deli/Juice Bar
   • Harvest Moon does not have seasonal or short term employment                    7-2, 7:30-3:30
   • Most employees have a typical or routine schedule, but shifts and               2 – 9:15
       hours are subject to change                                                Ideal number of hours
                                                                                  per week:
If needed, we can provide you assistance to complete this application.               10      15    20
This application is intended for use in evaluating your qualifications for           30      40
employment. This is not an employment contract. When you sign this                All positions work at
application (on the last page), you promise that the information is true,         least one weekend
correct and complete. All qualified applicants will receive consideration         day/week.
without regard to race, color, creed, religion, national origin, gender,             Check all that apply
marital status, status with regard to public assistance, membership in a          Any Position
local commission, the presence of disabilities, sexual orientation, age, or          morning evening
other characteristics protected by law. In addition to the application, other     Cashier – Customer
assessments, including, but not limited to, interview, job related skill          Service
testing, personality testing, background verification and reference                   8-3, 9-4     11-7
verification may be required prior to employment. This application will be           2 – 9:30
considered active for sixty days. If you wish to be considered for                Cook
employment after sixty days, or for a different position, you may have to            8-3
complete another application. If you are under 18 years of age, you may           Dishwasher
be required to provide additional documents to be eligible for work.                 8:30-2        4 – 9:30
                                                                                  Deli 7-2, 7:30-3:3
                                                                                     2 – 9:15
                                                                                  Grocery – Stocker
Where did you hear about this job? ____________________________________              5-1, 6-2, 7-3
                                                                                      9-5      3-9:30
If you are offered a position, how soon could you start? ______________________   Health and Body Care
                                                                                     8-4        12-8
What days and times are you not available? ______________________________         Produce
                                                                                     6-2        3-9:15
                                                                                  Other Position:
Current or Most Recent Company _____________________________________________________________

City ___________________________________ State _______ Phone _______________________________

Position ___________________________________________ Employed from ___________ to ___________

Duties _________________________________________________________________________________

______________________________________________________________________________________

Reason for leaving ________________________________________________________________________

Supervisor ____________________Supervisor’s Title ____________________Phone Number_____________

May we contact them?      yes      no



Company _______________________________________________________________________________

City ___________________________________ State _______ Phone _______________________________

Position ___________________________________________ Employed from ___________ to ___________

Duties _________________________________________________________________________________

______________________________________________________________________________________

Reason for leaving ________________________________________________________________________

Supervisor ____________________Supervisor’s Title ____________________Phone Number_____________



Company _______________________________________________________________________________

City ___________________________________ State _______ Phone _______________________________

Position ___________________________________________ Employed from ___________ to ___________

Duties _________________________________________________________________________________

______________________________________________________________________________________

Reason for leaving ________________________________________________________________________

Supervisor ____________________Supervisor’s Title ____________________Phone Number_____________

Please provide employment history for at least the past 3 years. Use additional sheets if needed.
Education
School / Program                             Location                  Graduate?        Degree / License

                                                                              yes

                                                                              yes

                                                                              yes

Do you have a legal right to work in the United States?                                             yes          no

Are you able to perform the essential duties of the position with or without a reasonable
accommodation? (If you have any questions about the functions of the job, please ask the            yes          no
interviewer before answering this question.)

Is anyone related to you employed by Harvest Moon Co-op?                                            yes          no

Have you been convicted of a crime in the past seven years?                                         yes*         no

*If yes, please explain:
A record of criminal conviction does not automatically exclude a candidate from
consideration.
Convictions will be evaluated based on the circumstances of the conviction and the position.
Certification and Release
I certify that I have read and understand this entire application and that the answers and statements given by me are
true and correct to the best of my knowledge. I understand that any false information on the facts called for in this
application may result in rejection of my application, or, if hired, immediate termination of employment.

I understand that submission of an application does not guarantee employment. I further understand that, should an
offer of employment be extended by Harvest Moon Co-op that such employment with Harvest Moon Co-op is at will, for
no specified duration and may be terminated by either Harvest Moon Co-op or myself at any time, with or without cause
or notice. I understand that none of the documents, policies, procedures, actions, statements of Harvest Moon Co-op
or its representatives used during the employment process is deemed a contract of employment real or implied. I
understand that no representative of Harvest Moon Co-op has the authority to enter into any agreement guaranteeing
any conditions of employment.

In consideration for employment with Harvest Moon Co-op, if employed, I agree to conform to the rules, regulations,
policies and procedures of Harvest Moon Co-op at all times and understand that such obedience is a condition of
employment. I understand that if offered a position with Harvest Moon Co-op, I may be required to submit to a pre-
employment medical examination, drug screening and background check as a condition of employment. I understand
that an unsatisfactory result from, refusal to cooperate with, or any attempt to affect the results of these pre-
employments tests and checks will result in withdrawal of any employment offer or termination of employment if
already employed.

I herby authorize any and all schools, former employers, references, courts and any others who have information about
me to provide such information to Harvest Moon Co-op and/or any of its representatives, agents or vendors and I
release all parties involved from any and all liability for any and all damage that may result from providing such
information.

BY SIGNING BELOW I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE STATEMENTS.
Signed __________________________________________________ Date __________________________

Name (printed) ___________________________________________________________________________

								
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