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APPLICATION FOR EMPLOYMENT
Ag Connection Sales, Inc. dba Sure Crop
877 Hwy 36
Seneca, KS 66538
We consider applications for all positions without regard to race, color, regligion, creed, gender, national origin, age, disability, mariatal or vetern status, or any other legally protected status.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER
Personal Information
First Name
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Middle Name
*
Last Name
*
Social Security #
*
Address 1
*
Address 2
City
*
State
*
Zip Code
*
Phone
*
Email Address
*
Position Applying For
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Truck Driver
Warehouse Help
Office Position
Other
Are you legally authorized to work in the United States?
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Yes
No
Have you ever been convicted of a felony?
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Yes
No
If yes, please explain.
Have you ever filed an application with us before?
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Yes
No
If yes, give date
Have you every been employed with us before?
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Yes
No
If yes, give dates
Are you currently employed?
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Yes
No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status?
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Yes
No
Availability
Date available for to start work?
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Are you available to work?
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Full-time
Part-time
Are you currently on "lay-off" status and subject to recall with other employment?
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Yes
No
Are you available to travel if a job requires it?
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Yes
No
Education
High School Name
*
Highschool Address
*
Years Completed
*
Diploma/Degree
*
Completed
Not Completed
Other
Other
Undergraduate College Name
Undergraduate College Address
Years Completed
Area of Study
Diploma/Degree
Completed
Not Completed
Other
Other
Graduate/Professional Name
Graduate/Professional College Address
Years Completed
Area of Study
Diploma/Degree
Completed
Not Completed
Other
Other
Employment History
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origion, disabilities or other protected status.
Employer 1
Company Name
City, State, Zip
Start Date
+
End Date
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Position
Salary
Supervisor/Manager
Reason for Leaving
May we contact?
*
Yes
No
Phone
Employer 2
Company Name
City, State, Zip
Start Date
+
End Date
+
Position
Salary
Supervisor/Manager
Reason for Leaving
May we contact?
*
Yes
No
Phone
Employer 3
Company Name
City, State, Zip
Start Date
+
End Date
+
Position
Salary
Supervisor/Manager
Reason for Leaving
May we contact?
Yes
No
Employer 4
Company Name
City, State, Zip
Start Date
+
End Date
+
Position
Salary
Supervisor/Manager
Reason for Leaving
May we contact?
Yes
No
Phone
Phone
Please provide explanation for any gaps in employment if appropriate
References
Professional/Personal Reference 1
Name
Title
Email Address
Phone
Professional/Personal Reference 2
Name
Title
Email Address
Phone
Professional/Pesonal Reference 3
Name
Title
Email Address
Phone
Additional Skills
List any additional skills that you would like to mention.
List professional, trade, business or civic activities and offices held
Describe any job-related training received in the United States military
Please submit a copy of your resume if desired
I certify that answers given herin are true and complete.
*
Yes
No
I authorize investigation of all statments contained in this application for employment as may be necessary in arriving at an employment decision.
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Yes
No
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge the Employee at any time with or without cause. It is further understood that that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
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Yes
No
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also that I am required to abide by all rules and regulations of the employer.
*
Yes
No
Signature of Applicant
*
clear
Date
*
+
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