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Broadacres Marketplace is a great family-oriented place to work. We provide our team members with jobs that enable them to provide for their families as well as grow and prosper both personally and professionally.

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Name *

First

Last

Have you ever applied or been employed with us? *

Preferred email address

Name Used

Month & Year

Location

Position Desired

Pay Expected

Are you legally eligible for employment in the United States? *

If hired, can you provide verification of your legal right to work in the US? *

Will you work overtime if asked? *

Are you 18 years of age or older? *

Do you have a valid work permit?

Other special training or skills (computer, machine operation, etc.)

Foreign language(s) spoken fluently which would be helpful in position sought:

How did you hear of our organization?

Have you ever been dismissed or asked to resign from a job?

Please explain

Have you used any other names under which employment or education may be verified?

Please explain

Are any of your relatives currently working within this company?

Name(s) and Location(s)

Did you go to, or are you currently attending, college?

Name and Location of College

Course of study

No. of years completed

Did you graduate?

List degree or diploma

Did you go to, or are you currently attending, High School?

Name and Location of High School

Course of study

No. of years completed

Did you graduate?

List degree or diploma

Any other education?

Name and Location of School

Course of study

No. of years completed

Did you graduate?

List degree or diploma

Describe your duties and any special training

Branch of Service

Period of Active Duty From/To (Month & Year)

Rank at Discharge

Company Name

Address

Status

Name of Supervisor

State Job Title & Describe Your Work

Reason for Leaving

May We Contact This Employer?

Please tell us why you would prefer we don't contact this employer.

Company Name

Address

Status

Name of Supervisor

State Job Title & Describe Your Work

Reason for Leaving

May We Contact This Employer?

Please tell us why you would prefer we don't contact this employer.

Company Name

Address

Status

Name of Supervisor

State Job Title & Describe Your Work

Reason for Leaving

May We Contact This Employer?

Please tell us why you would prefer we don't contact this employer.

Acknowledgment 1 *

I authorize any person, school, current employer (except as expressly noted), past employer(s), and organizations named in this application form (and accompanying resume or other documentation, if any) to provide Newport Diversified, Inc. with relevant information and opinion, personal or otherwise, that may be useful in making a hiring decision. I release all parties from all liability for any damage that may result from furnishing informatoin and opinion to you.

Acknowledgment 2 *

In consideration of employment, I agree to obey the rules and standards of Newport diversified, Inc. I understand that nothing in this application or in the interview process is intended to create a contract between the Company and myself for either employment or for the providing of any benefits. I agree that my employment is at-will and the terms of employment may be changed with or without cause, with or without notice, including but not limited to termination, demotion, promotion, transfer, compensation, benefits, duties and location of work, at any time, for any reason, at the option of myself or the Company. This consitutes my entire agree with Newport Diversified, Inc. with regard to the length of my employment.

Acknowledgment 3 *

I understand that as a condition of employment I may be required to take a post-offer/pre-employment physical examination which may include an alcohol and drug test. I further understand that at any time during my employment, I may be required to take a physical examination which may include an alcohol and drug test if management reasonably suspects a condition exists that may cause me to perform my job in a manner that may endanger my health or the safety and health of others. I authorize all providers of health care who examine me to disclose to the Company or its agents, all medical information revealed during such examinations. I further authorize Newport Diversified, Inc. to disclose such information to any other persons, if at any time my medical condition is put at issue in any proceeding by myself or others. In the event that I have a disability which will affect my ability to take the test, I will so inform the Company so that a reasonable accomodation can be made. Newport Diversified, Inc. reserves the right to require medical documentation concerning the need for accommodation.

Acknowledgment 4 *

I understand that all offers of employment are conditioned upon my providing satisfactory documentary proof of my identity and legal right to live and work in the United States.

Acknowledgment 5 *

I hereby acknowledge that I have read the above statements and understand them. I certifythat I, the undersigned applicant, have personally completed this application. I declare under penalty of perfury that the facts contained in the application (or any resume or other documents submitted) are true and complete to the best of my knowledge. I understand that any misrepresentations or omissions will disqualify me from further consideration for employment, and will be justification for my dismissal from employment, if discovered at a later date.

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