Application for Employment

Personal Information

First Name*

Last Name*

Middle Name

Address

Address City State Zipcode

Email*

Phone

Mobile Phone

Are you at least 18 years of age?*

Yes

If you are not at least 18 years of age, how old are you?

Are you legally eligible for employment in the United States? (If hired, Employment Verification is required by law.)*

Yes

Position Desired*

Full-Time*

Yes

Part-Time*

Yes

Seasonal*

Yes

Best Time to Contact*

Date available for employment:*

Hourly Rate/Salary Desired

Are you currently employed?

Yes

If no, how long have you been unemployed?

Have you been previously employed by Agriteer, LP?

Yes

If Yes, when?

Position

Do you have a valid driver’s license?

Yes

Do you have a valid commercial driver’s license (CDL)?

Yes

Are you able to perform all of the essential functions of the job for which you have applied, with or without reasonable accommodation?

Yes

If hired, will you work overtime as required?

Yes

Have you been discharged or fired from any job that you have held within the past 10 years?

Yes

If you answered yes above, please describe the circumstances involved.

Indicate special qualifications or skills:

Education

High School

Choose highest grade completed

College, trade or business

Years completed

Graduate Studies

HIgh School Name and Address

Major Studies

Degree, Diploma, License or Certificate

College / University Name and Address

Major Studies

Degree, Diploma, License or Certificate

Vocational School Name and Address

Major Studies

Degree, Diploma, License or Certificate

Employment Experience

#1

Current Employer

Phone

From

Address

City, State, Zip

Position

Duties

Supervisor's Name

Reason for Leaving

May we contact your employer?

Yes

#2

Current Employer

Phone

From

Address

City, State, Zip

Position

Duties

Supervisor's Name

Reason for Leaving

May we contact your employer?

Yes

#3

Current Employer

Phone

From

Address

City, State, Zip

Position

Address

Duties

Supervisor's Name

Reason for Leaving

May we contact your employer?

Yes

Professional References

(Please provide the names of 3 persons not related to you – 2 professional & 1 personal preferred).

Name

Address

Phone # or Email

Occupation

Years Acquainted

Name

Address

Phone # or Email

Occupation

Years Acquainted

Personal References

Name

Address

Phone # or Email

Occupation

Years Acquainted

Name

Address

Phone # or Email

Occupation

Years Acquainted

APPLICANT’S AUTHORIZATION AND CERTIFICATION

PLEASE READ CAREFULLY

I understand that providing false information on an application for employment is grounds for the Company to refuse to hire me, or to terminate my employment in the event that the misrepresentation is discovered after I have been hired. In submitting this application for employment, I authorize the Company to investigate all statements contained in it, and I understand that my current and/or former employers may be contacted to provide information concerning my suitability for employment, and that the references whom I have listed above will be contacted concerning my suitability for employment. I expressly authorize the Company to conduct such inquiries and I release the Company and any responding parties from any and all liability associated with such inquiries I understand that in the event that I am hired, I will be hired as an at-will employee, and my employment may be terminated at any time, with or without cause, at the option of either the company or myself. I understand that no representative of the Company except the President has any authority to enter into any legally binding employment agreement. I certify that I have read this entire employment application, including all information that I have provided on the application, and the entire statement set forth immediately above. I further certify that all of the information that I have provided on this employment application is true and correct.

Date*

Signature*

Comments

This field is for validation purposes and should be left unchanged.

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