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Step 1 of 5 - One

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ACCEPT OR REJECT APPLICANT
- Accepted
- Rejected
- Not selected
FULL NAME*
First Middle Last
LAST FOUR OF YOUR SNN*
PHONE*
ADDRESS*
PRESENT ADDRESS CITY LIVE HERE HOW LONG? ZIP CODE
LAST PREVIOUS ADDRESS*
Same as previous

PREVIOUS ADDRESS CITY LIVE THERE HOW LONG? ZIP CODE
STATE*
PREVIOUS ADDRESS STATE
POSITION(S) APPLIED FOR*
SHIFT REQUESTED*
- FIRST SHIFT
- SECOND SHIFT
- THIRD SHIFT
JOB TYPE*
- FULL-TIME
- PART-TIME
RATE OF PAY EXPECTED*
HAVE YOU WORKED FOR THIS COMPANY BEFORE*
- YES
- NO
IF YES, WHEN WERE YOU EMPLOYED?*
HAVE YOU APPLIED AT THIS COMPANY BEFORE?*
- YES
- NO
IF YES, WHEN?*
EMAIL ADDRESS
Enter Email Confirm Email
ARE YOU ELIGIBLE FOR EMPLOYMENT IN THE U.S.?*
- YES
- NO
NAME RELATIVES/FRIENDS WORKING FOR US
ARE YOU OVER 18?*
- YES
- NO
FACILITY APPLYING AT:*
- KENOSHA,WI
- COLUMBUS,OH
- NORCROSS,GA
LIST SPECIAL SKILLS/MACHINERY YOU CAN OPERATE?

Education
Website
ELEMENTARY SCHOOL
NAME COURSE OF STUDY NO. OF YEARS ATTENDED DID YOU GRADUATE
HIGH SCHOOL OR G.E.D
NAME COURSE OF STUDY NO. OF YEARS ATTENDED DID YOU GRADUATE
COLLEGE
NAME COURSE OF STUDY NO. OF YEARS ATTENDED DID YOU GRADUATE
GRADUATE SCHOOL
NAME COURSE OF STUDY NO. OF YEARS ATTENDED DID YOU GRADUATE
TRADE,BUSINESS OR OTHER
NAME COURSE OF STUDY NO. OF YEARS ATTENDED DID YOU GRADUATE

Previous Work History
LIST BELOW LAST FOUR EMPLOYERS, STARTING WITH LAST ONE FIRST
NAME ADDRESS RATE OF PAY POSITION REASON FOR LEAVING
FROM
MM
DD
YYYY
TO
MM
DD
YYYY
NAME ADDRESS RATE OF PAY POSITION REASON FOR LEAVING
FROM
MM
DD
YYYY
TO
MM
DD
YYYY
NAME ADDRESS RATE OF PAY POSITION REASON FOR LEAVING
FROM
MM
DD
YYYY
TO
MM
DD
YYYY

EMERGENCY CONTACT
NAME AND ADDRESS*
PHONE*
PERSONAL REFERENCES
NAME*
RELATIONSHIP(NON RELATED)*
PHONE*
NAME*
RELATIONSHIP(NON RELATED)*
PHONE*
NAME*
RELATIONSHIP(NON RELATED)*
PHONE*

HOW DID YOU HEAR ABOUT US?
Please let us know how you found out about our Company by selecting one of the following choices:
- NEWSPAPER
- EMPLOYEE OF BIRCHWOOD FOODS/KENOSHA BEEF
- JOB CENTER
- INTERNET
- OTHER
PLEASE SPECIFY YOUR SOURCE(NAME/URL)

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About Us
Foodservice
Retail
- Premium Ground Beef
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Culinary Café
Careers