Employment Application

Applicant Information

Position applied for

Current Employee Referral?

Yes No

If so, name of employee:

How did you hear about us?

Special training or skills (languages, machine operations, etc.) that would benefit you in the job for which you are applying

Would you accept full-time work?

Yes No

Would you accept part-time work?

Yes No

On what date, would you be available for work?

Have you ever been employed here?

Yes No

Are you legally eligible for employment in the United States? (If yes, proof is required if hired.)

Yes No

If you are under 18 years old, can you provide a work permit if required?

Yes No

Educational Background

Did you graduate?

Yes No

Did you graduate?

Yes No

Did you graduate?

Yes No

Vocational Training/Other:

Did you graduate?

Yes No

Continuing Education:

Employment Experience

I certify that all the information submitted by me on this application is true and complete, and understand that if any false or misleading information, omissions, or misrepresentations are discovered, my application may be rejected, and if I am employed, my employment may be terminated at any time. If hired, I agree to conform to the company rules and regulations, and I understand that these rules and/or employee handbook do not form a contract of employment either expressed or implied, and I agree that my employment and compensation can be terminated, with or without cause and with or without notice, at any time, at either my or the company’s option. 1 also understand and agree that the terms and conditions of my employment may be changed, with or without cause and with or without notice, at any time by the company. I understand that no company representative, other than its president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time or to make any agreement contrary to the foregoing. 1 expressly authorize, without reservation, the employer, its representative, employees, or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. Thereby waive any and all rights and claims I may have regarding the employer, its agents, employees, or representative, for seeking, gathering, and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations, or organizations for furnishing such information about me. I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

I Agree

List your most recent employer first.

Do Not Contact Employer

Dates employed from:

Hourly rate/salary start:

Hourly rate/salary final:

Do Not Contact Employer

Dates employed from:

Hourly rate/salary start:

Hourly rate/salary final:

Do Not Contact Employer

Dates employed from:

Hourly rate/salary start:

Hourly rate/salary final:

Do Not Contact Employer

Dates employed from:

Hourly rate/salary start:

Hourly rate/salary final:

I certify that all the information submitted by me on this application is true and complete, and I understand that if any false or misleading information, omissions or misrepresentations are discovered, my application may be rejected, and if I am employed, my employment may be terminated at any time.

I Agree

MVR Release Authorization

Personal and Employment Background Check

Social Security Number

Driver's License Number

Hazmat / Tank

Yes No

Current DOT Physical

Yes No

My Driving Record along with my personal and employment background may be obtained as part of the Farm Service Cooperative’s evaluation of my job application/employment. The reports may be procured by Farm Service Cooperative, and may include my driving record and an assessment of my insurability under the Company’s insurance coverage’s. Before any adverse action is taken, based in whole or in part on the information contained in my Driving Record, I will be provided a copy of the record, the name, address and telephone number of the reporting agency, and a summary of my rights under the Fair Credit Reporting Act, as well as additional information on my rights under the law. By signing this disclosure, I hereby authorize the Company to procure such reports about me from time to time, as it deems appropriate, to evaluate my insurability or for other permissible purposes.

I Agree