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Today's Date

Referral Source

Personal Information

Name*

First Middle Last

Address*

Street Address City State ZIP Code

Cell Phone*

Home Phone

Best Phone to Reach Me*

Email Address*

Employment Desired

Position applying for:*

Date You Can Start*

Salary Desired

Available*

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

(Please Check All That Apply)

Are you looking for*

Part-time

Full-time

What hours are you available to work?*

Education

* The age discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but not less than 70 years of age.

Grammar School

Name and Location of School

No. of Years Attended *

Did you Graduate?

Area(s) of Concentration

High School

Name and Location of School

No. of Years Attended*

Did you Graduate?

Area(s) of Concentration

College

Name and Location of School

No. of Years Attended*

Did you Graduate?

Area(s) of Concentration

Trade/ Correspondence

Name and Location of School

No. of Years Attended*

Did you Graduate?

Area(s) of Concentration

General

Extra-curricular activities and achievements:

U.S. Military or Naval Service

Yes

Employment Experience

List present and past employers beginning with your most recent position

Date Employed From/To*

Employer*

Employer Phone Number*

Employer Address

Street Address Address Line 2 City State ZIP Code

Position

Salary

Reason for Leaving*

Employer 2

Date Employed From/To*

Employer*

Employer Phone Number*

Employer Address

Street Address Address Line 2 City State ZIP Code

Position

Salary

Reason for Leaving*

Employer 3

Date Employed From/To*

Employer*

Employer Phone Number*

Employer Address

Street Address Address Line 2 City State ZIP Code

Position

Salary

Reason for Leaving*

References

Give the names of three persons not related to you, whom you have known at least one year.

References #1*

Full Name

City & Phone

Relationship

Years Known

References #2*

Full Name

City & Phone

Relationship

Years Known

References #3*

Full Name

City & Phone

Relationship

Years Known

Additional comments, skills or information you feel is relevant to the position you are applying for:

Positions that require operating a company vehicle or mileage reimbursement, must submit upon acceptance of a formal employment offer, approval for Farmward Cooperative to attain your current Motor Vehicle Report (MVR). MVR's will be reviewed to determine your insurability based on Farmward's insurance carrier and company policy. Failure to be insurable may be cause for an employment offer to be rescinded.

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Applicant Statement

Date*

Consent*

I certify that the facts contained in the application are true and complete to the best of my knowledge and understand that, if hired, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any prior notice.

Signature*

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Employment Application

Personal Information

Employment Desired

Current Employment

Education

General

Employment Experience

References

Applicant Statement

711 Front Street, Morgan, MN 56266

507.249.4019

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