Employment Application
Tartine is an Equal Opportunity Employer
Company Policy prohibits discrimination on the basis of Race, Color, Religion, Gender, Age, Disability or any otherconsideration made unlawful by Federal, State, or Local Laws.

Please drop off the completed employment application to Tartine or fax it to 619-435-2374.

GENERAL INFORMATION
Name: _____________________________________
Address:__________________________________________________________

City: _____________________________ State: ___________ Zip: ____________
Telephone: ____________________ Email Address: ___________________________
Position Desired: ___________________ Salary Desired: ___________
Date available: _____________________ Full time □ Part Time □ Seasonal □Yes

□ No □Yes□ No □Have you ever applied to this company before?

If yes, when?

If less than 18 years of age do you have a work permit?

Do you require any reasonable accommodation in order to perform the essentialfunctions of the position you are applying for?

General Availability:

Monday:_________________
Tuesday:_________________
Wednesday:_________________
Thursday:_________________

Friday:_______________
Saturday_______________
Sunday:_______________

Yes□ No □WORK EXPERIENCE
Please list your previous work experience beginning with themost recent:
DateStart

Employer Name, Address, and Phone

TitleEndFinal Wage
Supervisor

Reason for leaving

Date
Start

Employer Name, Address and Phone

Title

End
Final Wage
Supervisor

Reason for leaving

Date
Start

Employer Name, Address, and Phone

Title

End
Final Wage
Supervisor

Reason for leaving

Date
Start

Employer Name, Address, and Phone

Title

End
Final Wage
Supervisor

Reason for leaving

May we contact your current employer? Yes □ No □

Describe the main responsibilities you had at these jobs:

How did become aware of Tartine?

Why are you applying for a job at Tartine?

Why/how do you think you would as value as a member of the Tartine staff?

If you have had previous experience with our service, please describe it.

Are there any special skills or experience that may benefit your candidacy for this job?

REFERENCES
Please list three professional references (do not includerelatives).
Name
Email Address
Phone

Occupation

RelationshipYears Known

Name
Email Address
Phone

Occupation

RelationshipYears Known

Name
Email Address
Phone

Occupation

RelationshipYears Known

EDUCATION AND TRAINING
The California Fair Employment and Housing Act, Title VII and the AgeDiscrimination in Employment Act of 1967 prohibits discrimination on thebasis of age with respect to individuals who are age 40 and above.

SchoolHigh School

College

Additional Training# of Years
CompletedDegree
CompletedBACKGROUND QUESTIONSWhat foreign languages do you speak (if any)_____________ Fluently?
Yes



□ No□

If Employment is offered, can you present evidenceof your legal right to work in the U.S.?
Yes□ No □Have you ever been involuntarily terminated or forced
to resign from any employment?
Yes□ No □If yes, please explain:_________________________________________Have you ever been convicted of a felony crime ortheft-related misdemeanor in the last five years?
Yes-□ No □Convictions will not necessarily disqualify applicant.

.

If yes, please list dates, offenses and disposition:__________________________________________

APPLICANT’S STATEMENT

I,

certify that all answers or statements

given in this application are true and correct without omissions. I authorize Taritne
to thoroughly investigate all of the statements contained in this application as partof the process of arriving at an employment decision of my persona. I acknowledge
that any false statement or misrepresentation on this application, resume, orsupplemental materials will be cause for refusal to hire or for immediate dismissalfrom employment at any time during the period of my employment.
If I am employed, I agree to abide by the policies and procedures by which
Tartine operates.
I understand that employment is at will. This means that I do not have a contractof employment for any particular span of time and that Tartine or I may terminate
the employment relationship for any reason, with or without cause or notice, at anytime.

Signature:Date: ________________________________________