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Temporary

Program Coordinator: Mobile & Permanent School Pantry

Application Form

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Enter “NA” for any sections that are not applicable.

Date of Application*

How did you hear about Second Harvest?

Name*

First Middle Last

Email address*

Contact number*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Position(s) applied for*

Desired Compensation*

Are you legally eligible for employment in the U.S.: **

(proof of identity and authorization to work in the U.S. is required upon commencement of employment)

Have you ever been employed by SHFB before?*

Driver’s license number (Required for all driver positions)

State

Class

I am available to work*

Date available to start work*

Do you know anyone who is currently employed with Second Harvest?*

If yes, please identify (by name and relationship)

Languages spoken other than English

High School Name and Location*

Did you graduate?*

College Name and Location*

Major / Degree Achieved*

Other Educational Institution(s)

Other Degree / Certification Achieved

Summarize special skills and qualifications acquired from employment, membership in professional organizations or other experiences that may qualify you for work with Second Harvest. Exclude any that indicate race, color, national origin, ancestry, religion, sex, gender (including gender identity and gender expression), sexual orientation, political affiliations or activities, military service/veteran status, marital status, pregnancy, age (over 40), physical or mental disability, medical condition, or any other legally protected basis.

Summarize

Contact Info for Reference #1

Reference*

Name*

Phone number*

Email address*

Contact Info for Reference #2

Reference*

Name*

Phone number*

Email address*

Contact Info for Reference #3

Reference*

Name*

Phone number*

Email address*

Starting with the most recent, list your prior employers or work experience for the past 10 years. You may include military service and volunteer activities that are related to job experience.

Job #1

From*

To*

Employer / Address / Phone*

Job title and duties

Last direct supervisor/title/contact number

Reason for leaving*

Job #2

From

To

Employer / Address / Phone

Job title and duties

Last direct supervisor/title/contact number

Reason for leaving

Job #3

From

To

Employer / Address / Phone

Job title and duties

Last direct supervisor/title/contact number

Reason for leaving

Job #4

From

To

Employer / Address / Phone

Job title and duties

Last direct supervisor/title/contact number

Reason for leaving

Job #5

From

To

Employer / Address / Phone

Job title and duties

Last direct supervisor/title/contact number

Reason for leaving

Declaration*

I agree to the following:

I hereby certify that all of the foregoing information I have supplied in this application is correct and complete. I hereby authorize Second Harvest Food Bank of Orange County, Inc. (“Second Harvest”) to verify the information provided. I understand that any falsification or material omission of information will constitute grounds for withdrawal of any employment offer or termination of employment. I give Second Harvest permission to contact each of my previous employers and references, and hereby release Second Harvest from any and all liability for doing so.

I also understand that all offers of employment are conditioned upon the satisfactory completion of reference and/or background checks, and the submission of valid documentation that confirms my identity and authorization to work in the United States. If I receive a conditional offer of employment I will be asked to provide information regarding criminal convictions, which are not necessarily a bar to employment, but will be considered in a manner consistent with all applicable law. Second Harvest will also consider factors such as the nature of the crime, the time elapsed, and the nature of the job.

If hired, and in consideration of my employment, I agree to comply with Second Harvest’s rules, policies and procedures.

I understand that employment with Second Harvest is “at-will,” which means that both Second Harvest and I may terminate my employment at any time, with or without cause or prior notice. In addition, Second Harvest may change my position, duties, schedule and/or compensation, and may transfer, reassign, promote, demote, suspend or otherwise change the terms and conditions of my employment (other than the at-will relationship), with or without cause or prior notice. I further understand that no one has any authority to enter into an agreement of employment with Second Harvest for any specified time period, or to make any agreement contrary to the foregoing unless in writing signed by the Director of Human Resources.

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