Please enable JavaScript in your browser to complete this form.12345Farmstead Butcher Block Application | Section 1Date *Name *FirstLastAddress *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Do you have a valid driver's license? *YesCDLNoNextJob Listings | Section 2You can apply for multiple positions. Custodian/JanitorialOffice/Clerical**Applicant for these jobs must be 18 years of age to comply with federal laws regarding the operation of some equipment.**Cashier**Slaughter Plant Assistant Manager**Butcher**Meat Cutter**Retail Clerk, Full Service Meat Counter**Meat Clerk, Packager**Meat Clerk, StufferDesired Salary (per hour) *Date available for work *Have you ever worked for this company before? *YesNoIf yes, what was your position and when did you leave?Have you ever been convicted of a felony? *YesNoIf you have been convicted of a felony, please explain.NextEducation | Section 3High School Attended *Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDid you graduate or receive a GED? *YesNoList any vocational, trade schools, or colleges you have attended. Did you graduate? What is your degree?Professional Reference | Section 4Reference 1Reference name 1 *FirstLastRelationship *PhoneEmailAddressAddress Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeProfessional Reference | Section 5Reference 2Reference name 2 *FirstLastRelationship *PhoneEmailAddressAddress Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeNextEmployment History | Section 6I am currently employed *YesNoCurrent or most recent past employer company namePhoneEmailAddressAddress Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSupervisorJob titleResponsibilitiesFromToStarting hourly salaryEnding or current hourly salaryReason for leavingMay we contact your current or previous employer/supervisor for a reference?YesNoEmployment History | Section 7Company namePhoneEmailAddressAddress Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSupervisorJob titleResponsibilitiesFromToStarting hourly salaryEnding hourly salaryReason for leavingMay we contact your previous employer/supervisor for a reference?YesNoEmployment History | Section 8Company namePhoneEmailAddress Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSupervisor Job titleResponsibilitiesFromToStarting hourly salaryEnding hourly salaryReason for leavingMay we contact your previous employer/supervisor for a reference?YesNoDisclaimer and Signature | Section 9Next1. My answers are true and correct to the best of my knowledge. *Yes2. If this application leads to employment, I understand that any false or misleading information in the application or in my interview may result in my release from employment with Farmstead Butcher Block LLC *Yes3. I understand that a negative pre-employment drug test is required. I understand that I will be subject to random drug testing during my employment with Farmstead Butcher Block LLC and that a positive test could result in my immediate release from the company. *Yes4. Authorization for release of information referenced in this application. *YesI authorize investigation of any and all statements contained herein and the references listed to give you any and all information concerning my current/previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any and all damages that may result from furnishing same to Farmstead Butcher Block LLC. I understand and agree that, if hired, my employment is not for a definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice. This form has been designed to comply with state and federal fair employment practice laws prohibiting employment discrimination. Farmstead Butcher Block LLC is an equal opportunity employer.Why are you interested in working in the meat processing industry? Are you looking for a job or a long term career. Are you willing to be involved in on the job specialized-training related to this industry?Type your name here *By typing your name above, you indicate you have answered YES to questions number 1, 2, 3, and 4 in this section.Submit Farmstead Butcher Block 3060 Cleaton Road Central City, KY 42330 270-200-4224 office@mmmbutcherblock.com