Employment Application Job Application Apply Today! Vine & Branches is an Equal Opportunity Employer. All applicants will be considered for employment without regard to race, religion, color, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other status protected by the law. Position Applied For: * Employment Desired * Full-time Part-time For part time, list available days/hours * Requested Salary per hour/year: * $ Personal Information Name * First Last * Last Email * Confirm Email * Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Mobile Phone Home Phone Are you at least 18 years old? * Yes No When are you available to start work? * Have you ever worked for Vine & Branches? * Yes No If so, what position? * Education High School High School Name/Address Years Attended Degree Received Undergraduate Undergraduate Name/Address Years Attended Degree Received Masters Masters Name/Address Years Attended Degree Received Certifications Certifications Received with Expirations: Special Trainings Special Trainings Received: Experience (Start with most recent experience) Employer Address Phone Job Title Salary Dates of Employment Supervisor Reason For Leaving Description of Duties May we contact for a reference? Yes No plus1 Add Job minus1 Remove Job Have you ever been fired or asked to resign from a position? * Yes No If yes, please explain: * Have you ever been convicted of or are you the subject of pending charges of any crime within the state of Virginia or outside of the state of Virginia? * Yes No If yes, please explain: * If hired, you will be required to have a criminal records background check. Do you agree to having all required background checks run in your name? * Yes No If yes, please explain: * Is there any reason why you may not be able to perform the duties of your position? * Yes No If yes, please explain: * Please list the person to contact in case of emergency: Emergency Contact Address: Emergency Contact Phone Number: References (Please list 3 additional references not related to you) Name/Title Phone Email plus1 Add minus1 Remove I hereby affirm that the above information is true and complete to the best of my knowledge. I understand that it may be subject to verification. Should I be employed by Vine & Branches, any misrepresentation or false statement made on this application may be considered cause for possible dismissal. Vine & Branches has my permission to obtain all necessary information from the references I have listed concerning my prior employment. I release all parties from any possible damages resulting from disclosing such information with or without prior written notice from me. If hired, I understand this application is not considered a contract. In the Commonwealth of Virginia, I am considered an at will employee and may be terminated by Vine & Branches at any time. Signature signature keyboard Clear Today's Date Submit If you are human, leave this field blank. Sign Up for eNews Philosophy Enrollment
