Position Applying For
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Name & address of former employer
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Name *
A name is required.
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Phone *
A phone number is required.
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Supervisor
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Email *
An email address is required.
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Dates employed (from/to)
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Other Phone
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Salary (start/end)
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Reason for leaving
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Position held
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If presently employed, why do you desire to change your position?
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Are you able to perform the specific job tasks with or without reasonable accommodation?
Yes
No
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If you are able to perform one or more of the job functions with reasonable accommodation, please describe how you would perform the tasks and with what accommodation?
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Can you meet the attendance requirements of the job?
Yes
No
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EDUCATION
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Are you planning to pursue further studies?
Yes
No
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Do you speak French fluently?
Yes
No
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If so, when, where, and what courses?
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PERSONAL REFERENCES
Please list the names of three personal references who have known you well during the past FIVE or more years. You may include the names of friends or acquaintances presently employed by the Maine Woods Company LLC but do not list relatives, former employers or fellow employees.
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Have you ever been convicted of a criminal offense involving dishonesty or breach of trust (including but not limited to, robbery, larceny, shoplifting, embezzlement, forgery, perjury, tax evasion, etc.)?
Yes
No
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PLEASE READ BEFORE SUBMITTING
I certify the facts set forth in my application for employment are true and complete. I understand, if employed, false statements or materials omissions on this application may result in my dismissal. I authorize Maine Woods Company LLC to verify all statements contained in this application and to make any necessary reference checks and checks with prior employers.
I authorize the references and employers listed above to give Maine Woods Company LLC any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and I release the employers and references I have listed, as well as Maine Woods Company LLC, from liability from any damages which may result from furnishing the same to Maine Woods Company LLC.
If employed, I agree to conform to all the policies and procedures of Maine Woods Company LLC and recognize that my employment and compensation can be terminated with or without cause, and without notice at any time at the option of either Maine Woods Company LLC or myself.
I understand that no representative of Maine Woods Company LLC, other than the Executive Director and the Chairman of the Board acting together and in writing, has any authority to enter into an agreement for employment for a specified period of time or to make any agreement contrary to this paragraph.
By submitting this form, I agree to the above terms and conditions.
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Date
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