Ag-Power

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Application for Employment

Ag-Power, Inc. does not discriminate on the basis of race, color, religion, national origin, sex, age or disability. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors.

Each question should be fully and accurately answered. No action can be taken on this application until all questions have been answered. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related questions.

Referred By

Individual/Friend

Internet

Newspaper

Other

Are you seeking employment*

Full-time

Part-time

Temporary

Are you 18 years of age or older?*

Yes

If hired, can you furnish proof you are eligible to work in the U.S.?*

Yes

Have you ever applied here before?*

Yes

Were you ever employed here?*

Yes

You have been provided a job description for the position for which you are applying, including the physical requirements of the job. Are you capable of performing the job functions?*

Yes

If no, please explain

Have you ever been convicted of any law violation (except a minor traffic violation)?*

Yes

If yes, please explain

# of Years Completed, Diploma/Degree/Certificate, Subjects Studied

College or University

# of Years Completed, Diploma/Degree/Certificate, Subjects Studied

Vocational or Technical

# of Years Completed, Diploma/Degree/Certificate, Subjects Studied

What skills, additional training & licenses do you have that are related to the job for which you are applying?

List names of employers in consecutive order with present listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references. Please give month and year.

Job Title and Duties*

Job Title and Duties

Have you worked under any other name?*

Yes

Are you presently employed?*

Yes

If yes, may we contact?

Yes

Have you ever been fired from a job or asked to resign?*

Yes

If yes, please explain

List any relatives or friends at this company

Give three names of references, who are not relatives and you have known for at least one year.