…

                                                                  ApplicAtion for EmploymEnt
                                                                  EQUAL OPPORTUNITY EMPLOYER

                                                                  LOCATION (CIRCLE ONE):                         Pittsboro            Chapel Hill

                                                                  DATE ________________________________________________

                      name (Last name First)                                                                      soCiaL seCurity number
PERSONAL INFO




                      Present address                                             City                             state                                ZiP Code


                      Permanent address                                           City                            state                                 ZiP Code


                      Home PHone no.                                      CeLL PHone no.                          emaiL                          reFerred by



                      Position desired                                                           date you Can start                           saLary desired
POSITION DESIRED




                      are you                                                              iF so, may We inquire
                      emPLoyed?               yes            no                            oF your Present emPLoyer?                    yes            no

                      Have you ever aPPLied to                                             WHen?
                      CaroLina breWery beFore?                    yes            no

                      days/times avaiLabLe (CirCLe)
                      sun am       sun Pm     mon am     mon Pm      tues am tues Pm Wed am Wed Pm                tHu am      tHu Pm      Fri am     Fri Pm     sat am     sat Pm


                                         NAME & LOCATION                                                       YEARS                DID YOU                   SUbjECTS STUDIED
                                           OF SChOOL                                                         ATTENDED              gRADUATE?
EDUCATION hISTORY




                           grammar sCHooL

                             HigH sCHooL

                                 CoLLege

                        trade, business or
                      CorresPondenCe sCHooL

                      subJeCts oF sPeCiaL study/researCH WorK or sPeCiaL training/sKiLLs
gENERAL




                      us. miLitary or navaL serviCe                                                                         ranK



                                   DATE                        NAME & TELEPhONE OF EMPLOYER                    SALARY               POSITION                REASON FOR LEAVINg
                              MONTh AND YEAR
WORK hISTORY




                      From
                      to

                      From
                      to

                      From
                      to

                                NAME                         PhONE                              EMAIL                        RELATIONShIP              bUSINESS           YEARS KNOWN
REFERENCES




                    all facts are true and complete to the best of my knowledge. Falsified statements shall be grounds for dismissal. i authorize investigation of information provided
                    and release previous employer from all liability for any damage resulting from said information.


                    date                                                                 signature