• Application for Employment


    Qualified applicants receive equal consideration. No question is asked for the purpose of excluding any applicant due to race, creed, color, national origin, religion, age, sex, handicap, disability, veteran status, marital status, sexual orientation, or any other characteristic protected by law. WE ARE AN EQUAL OPPORTUNITY EMPLOYER. As a condition of employment, you will be required to have an influenza vaccine each “flu season” unless there is a legitimate reason, religious or medical, for declining. You will be required to wear a mask during flu season if not vaccinated.

    PLEASE COMPLETE AND SIGN ELECTRONICALLY.

  • Max. file size: 50 MB.
  • MM slash DD slash YYYY
  • If you have no reply to this question, please type NA.

  • EMPLOYMENT HISTORY (List present or most recent employer first)
    COMPLETE ADDRESSES ARE NECESSARY for all references: employer and personal.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type (111)111-1111
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type (111)111-1111.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type (111)111-1111
  • If you have no reply to this question, please type NA.
  • Fairhaven has a drug-free workplace program. If you are offered a position, you may be required to submit to a drug and/or alcohol screen. The offer of employment will be rescinded if you have a positive result.
  • MM slash DD slash YYYY

  • Education
  • If you have no reply to this question, please type NA.

  • Professional Data

  • Personal Information

  • (Note: you will be required to furnish documents to verify your eligibility for employment in accordance with the Immigration Reform and Control Act and your employment is contingent upon furnishing such documents.)
  • (A conviction does not automatically bar you from employment.)
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.

  • PERSONAL REFERENCES

    COMPLETE ADDRESSES ARE NECESSARY for all references.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.
  • If you have no reply to this question, please type NA.

  • I certify that the answers given by me to the foregoing questions and statements are true and correct without consequential omissions of any kind. I agree that the company shall not be held liable in any respect if my employment is terminated because of false statements, answers or omissions made by me in this application. I understand that any misleading or incorrect statements may render this application void, and if employed, may be cause for termination. I understand that a medical examination based on the requirements of the position for which I am being considered may be required, and drug testing may be included as part of the regular pre-employment physical.

    I also authorize the companies, schools or persons named above to give any information requested regarding my employment, character, and qualifications. I hereby release said companies, schools or persons from all liability for any damage for issuing this information. In consideration of my employment, I agree to conform to the rules and regulations of this organization. My employment and compensation can be terminated with or without cause, and with or without notice, at anytime, at the option of either my employer or myself.
  • MM slash DD slash YYYY


  • Reference Check Form

    Fairhaven Corporation is required by Wisconsin State law to complete a criminal history check.

    The following information is used for reference checking only. All information here will remain confidential. Fairhaven does not discriminate in hiring or employment on the basis of race, color, religious creed, national origin, sex or ancestry or on the basis of age or physical or mental handicap unrelated to ability to perform the work required. No information on this reference check form is intended to secure information to be used for such discrimination. The references will be given every consideration; however, its receipt does not imply that the applicant will be employed.
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY

  • Reference Request
  • I authorize the companies, schools or persons named below to give any information requested regarding my employment, character and qualifications. I hereby release said companies, schools or persons from all liability for any damage for issuing this information. In consideration of my employment, I agree to conform to the rules and regulations of this organization. My employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of either my employer or myself.
  • MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.