Swallowtail Farm

Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth: *

MM

DD

YYYY

Available Start Date: *

MM

DD

YYYY

Have you ever been convicted of a felony or a DUI? *

Yes

No

Are you legally able to work in the United States? *

Yes

No

Are you 18 years or older? *

Yes

No

Do you have a valid drivers license? *

Yes

No

Do you have reliable transportation? *

Yes

No

Have you worked outdoors in the Florida summer (or somewhere comparable) before? *

Yes

No

Are you able to perform heavy lifting tasks and daily farm labor? *

Yes

No

Have you worked with hand tools, power tools, machinery or equipment? *

Yes

No

Are you willing to work nights and weekends? *

Yes

No

Do you have medical insurance? *

Yes

No

Do you have any medical concerns or allergies? *

Yes

No

Do you have any physical limitations or injuries that may limit your ability to perform strenuous tasks? *

Yes

No