KOSHER EMPLOYMENT APPLICATION Herzog Wine Cellars and Tierra Sur are Equal Opportunity Employers Step 1 of 8 12% Name* First Middle Last Business Telephone*Home Telephone*Present Address* Street Address City State / Province / Region ZIP / Postal Code Email Address* Rabbi Name* Rabbi Telephone Number* EMPLOYMENT DESIREDPosition applying for:* Are you applying for:* Regular full-time work Regular part-time work Temporary work If applying for temporary work, during what period of time will you be available?* What days and hours are you available to work?* Would you be available to work overtime, if necessary?* Yes No If hired, on what date can you start work?* MM slash DD slash YYYY Salary or hourly rate desired:* Are you mechanically inclined?* Yes No Are you able to lift at least 50 pounds?* Yes No PERSONAL INFORMATIONHave you ever applied to or worked for this Company before?* Yes No If yes, when?* Do you have any friends or relatives working for this Company?* Yes No If yes, state name(s) and relationship* If hired, would you have a reliable means of transportation to and from work?* Yes No Are you at least 18 years old?* Yes No If under 18, hire is subject to verification that you are of minimum legal age and have a valid student work permit.If hired, can you present documentation establishing your legal right to employment in the United States?* Yes No Are you able to perform the essential functions of the job for which you are applying, with or without reasonable accommodation?* Yes No If no, describe the functions that cannot be performed* Hire may be subject to passing a medical examination. EDUCATION, TRAINING AND EXPERIENCEChederIf applicable, which Cheder (elementary school) did you attend? If multiple, please click the (+) to add additional schools.NameTownState MesivtaWhat Mesivta did you attend? If multiple, please click the (+) to add additional schools.NameTownState Please list your Rabbi’s name Do you have any other experience, training, qualifications or skills which you feel make you especially suited for work at this Company? If so, please explain: EMPLOYMENT HISTORYList below all present and past employment, whether paid or unpaid, starting with your most recent employer (last 10 years is sufficient). Account for all periods of unemployment. You must complete this section even if attaching a resume.Upload Your Resume Drop files here or Select files Max. file size: 5 MB. Employer Name and Address* Name of Employer Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Type of Business* Phone*Your Supervisor’s Name* Your Position and Duties:*Date Started* MM slash DD slash YYYY Date Ended* MM slash DD slash YYYY Reason for Leaving:* Employer Name and Address Name of Employer Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Type of Business PhoneYour Supervisor’s Name Your Position and Duties:Date Started MM slash DD slash YYYY Date Ended MM slash DD slash YYYY Reason for Leaving: MILITARY SERVICEHave you obtained any special skills or abilities as the result of military service? Yes No If so, describe: REFERENCES AND RABBINIC REFERENCESList below three persons not related to you who have knowledge of your work performance within the last three years.Reference #1* Name Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Occupation* Phone*Number of Years Acquainted*Reference #2* Name Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Occupation* Phone*Number of Years Acquainted*Reference #3* Name Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Occupation* Phone*Number of Years Acquainted* Please read carefullyPlease use the checkboxes to indicate your consent, then type your name and date to sign.I understand that persons employed at this Company have access to confidential information regarding various phases of the Company business. Therefore, the Company requires new employees, as a condition of employment, to sign a Confidentiality Agreement.*I understand that persons employed at this Company have access to confidential information regarding various phases of the Company business. Therefore, the Company requires new employees, as a condition of employment, to sign a Confidentiality Agreement. I agree*I understand that information concerning competitors’ operations, products, designs or other proprietary information will not be solicited from an applicant for employment, or from the Company’s employees. This Company will honor any valid post-employment restrictions contained in an applicant’s employment contract and fully respects the applicant’s duty of loyalty and non-disclosure to a former employer.*I understand that information concerning competitors’ operations, products, designs or other proprietary information will not be solicited from an applicant for employment, or from the Company’s employees. This Company will honor any valid post-employment restrictions contained in an applicant’s employment contract and fully respects the applicant’s duty of loyalty and non-disclosure to a former employer. I agree*I certify that the information provided herein is correct to the best of my knowledge and belief. I am aware that failure to complete this application, intentional omissions or misstatements may result in refusal of employment or discharge. I authorize the references and contacts listed to provide you with any and all relevant information, personal or otherwise, and I release all parties from all liability for any damages that may result from furnishing the same to you. I understand that offers of employment may be made contingent on the receipt of a satisfactory background check and references.*I certify that the information provided herein is correct to the best of my knowledge and belief. I am aware that failure to complete this application, intentional omissions or misstatements may result in refusal of employment or discharge. I authorize the references and contacts listed to provide you with any and all relevant information, personal or otherwise, and I release all parties from all liability for any damages that may result from furnishing the same to you. I understand that offers of employment may be made contingent on the receipt of a satisfactory background check and references. I agree*In consideration of my employment, if hired, I agree to conform to the rules and regulations set forth by this Company in its policies and practices or as directed by management.*In consideration of my employment, if hired, I agree to conform to the rules and regulations set forth by this Company in its policies and practices or as directed by management. I agree*I understand that each employee of this Company is an at-will employee unless specifically notified otherwise in writing. That is, I may terminate our employment relationship at any time, for any reason, and the Company has the same right to terminate our employment relationship at any time and for any reason. I understand that this at-will relationship cannot be modified or changed during my employment except by specific written agreement between me and the Company, signed by the Vice President of Operations of HWC.*I understand that each employee of this Company is an at-will employee unless specifically notified otherwise in writing. That is, I may terminate our employment relationship at any time, for any reason, and the Company has the same right to terminate our employment relationship at any time and for any reason. I understand that this at-will relationship cannot be modified or changed during my employment except by specific written agreement between me and the Company, signed by the Vice President of Operations of HWC. I agree*I understand that if offered employment I will be required to submit to a drug and/or alcohol screen. I further understand that I must successfully pass such a screen as a condition of beginning my employment. If test results are not received until after I start employment, a positive test will result in my termination.*I understand that if offered employment I will be required to submit to a drug and/or alcohol screen. I further understand that I must successfully pass such a screen as a condition of beginning my employment. If test results are not received until after I start employment, a positive test will result in my termination. I agree*Type your name to sign:* Date* MM slash DD slash YYYY
