Application for Employment

Please fill out all information below and a Waukon Feed Ranch, Inc. Representative will be touch shortly.

CLICK HERE TO PRINT AND MAIL/FAX APPLICATION

First Name *
Last Name *
Address: (Street)(City)(State & Zip Code) *
How Long? *
Telephone Number(s) *
Are you 18 or older? * Yes
No
Date of Birth: (Driving Positions Only) *
Position applying for: *
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If applying driving position please complete the following:
Driving Experience
Class of Equipment (Check all that apply) Straight Truck
Tractor/Semi
Tractor – Two Trailers
Other
Accident Record for Past Three Years
Date of Last Accident
Explain Nature of Accident
Date of Accident
Explain Nature of Accident
Date of Accident
Explain Nature of Accident
Traffic Convictions and Forfeitures for the past 3 years (other than parking violations)
Date
Location / Charge / Penalty
Date
Location / Charge / Penalty
Date
Location / Charge / Penalty
Have you ever been denied a license, permit or privilege to operate a motor vehicle? * Yes
No
Has any license, permit or privilege ever been suspended or revoked? * Yes
No
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Address for the Past Three Years
(Street)(City)(State & Zip Code) *
How Long?
(Street)(City)(State & Zip Code)
How Long?
(Street)(City)(State & Zip Code)
How Long?
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Education
Check Highest Grade Completed: * High School - 9th
High School - 10th
High School - 11th
High School - 12th
College - 2 Year
College - 4 Year
Trade/Specialty School
Business School
Year Graduated from Highest Level of School *
Studies: *
Degrees / Certifications and Licenses * HS Diploma
College 2 Year Degree
College 4 Year Degree
Other Licenses or Certificates
Other Licenses and Certificates. Please list below.
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REFERENCES (DO NOT INCLUDE FAMILY MEMBERS OR PAST SUPERVISORS)
NAME / PHONE NUMBER / BEST TIME TO CALL / OCCUPATION *
NAME / PHONE NUMBER / BEST TIME TO CALL / OCCUPATION *
NAME / PHONE NUMBER / BEST TIME TO CALL / OCCUPATION *
MAY WE CONTACT YOURE CURRENT EMPOYER FOR REFERENCES? * Yes
No
IF HIRED, WILL YOU BE ABLE TO WORK OVERTIME? * Yes
No
WILL YOU BE ABLE TO PERFORM THE ESSENTIAL JOB FUNCTIONS FOR THE POSITION YOU ARE APPLYING FOR WITH OR WITHOUT REASONABLE ACCOMMODATION? * Yes
No
HAVE YOU EVER BEEN CONVICTED OF A CRIME, EXCLUDING MISDEMEANORS AND SUMMARY OFFENSES, WHICH HAS NOT BEEN ANNULLED, EXPUNGED OR SEALS BY COURT? (A "YES" RESPONSE DOES NOT AUTOMATICALLY DISQUALIFY YOUR APPLICATION.) * Yes
No
HAVE YOU EVER BEEN DENIED A LICENSE, PERMIT OR PRIVILEGE TO OPERATE A MOTOR VEHICLE? * Yes
No
HAS ANY LICENSE, PERMIT OR PRIVILEGE EVER BEEN SUSPENDED OR REVOKED? * Yes
No
HOW DID YOU FIND OUT ABUT THIS POSITION?
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EMPLOYMENT RECORD
LAST EMPLOYER NAME *
ADDRESS *
POSITION HELD *
FROM *
TO *
SALARY *
REASONS FOR LEAVING *
SECOND LAST EMPLOYER NAME *
ADDRESS *
POSITION HELD *
FROM *
TO *
SALARY *
REASONS FOR LEAVING *
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TO BE READ AND SIGNED BY APPLICANT THIS CERTIFIES THAT THIS APPLICATION WAS COMPLETED BY ME, AND THAT ALL ENTRIES ON IT AND INFORMATION IN IT ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
CERTIFICATION & AUTHORIZATION ~ ALL APPLICANTS THE PREVIOUS INFORMATION IS TRUE AND CORRECT. I UNDERSTAND THAT, IN THE EVENT OF MY EMPLOYMENT BY THE COMPANY, I SHALL BE SUBJECT TO DISMISSAL IF ANY INFORMATION THAT I HAVE GIVEN IN THIS APPLICATION IS FALSE OR MISLEADING OR IF I HAVE FAILED TO GIVE ANY INFORMATION HEREIN REQUESTED, REGUARDLESS OF THE TIME ELAPSED AFTER DISCOVERY. I AUTHORIZE THE COMPANY TO INQUIRE INTO MY EDUCATIONAL, PROFESSIONAL AND PAST EMPLOYMENT HISTORY REFERENCES AS NEEDED TO RESEARCH MY QUALIFICARIONS FOR THIS POSITION. I HEREBY GIVE MY CONSENT TO ANY FORMER EMPLOYER TO PROVIDE EMPLOYMENT-RELATED INFORMATION ABOUYT ME TO THE COMPANY AND WILL HOLD THE COMPANY AND MY FORMER EMPLOYER HARMLESS FROM ANY CLAIM MADE ON THE BASIS OF SUCH INFORMATION ABOUT ME WAS PROVIDED OR THAT ANY EMPLOYMENT DECISION WAS MADE ON THE BASIS OF SUCH INFORMATION. I FURTHER AUTHOURIZE THE COMPANY TO OBTIAN ANY CREDIT AND CONSUMER CHECK. I UNDERSTAND THAT NOTHING IN THIS EMPLOYMENT APPLICATION, THE GRANTING OF AN INTERVIEW OR MY SUBSEQUENT EMPLOYMENT WITH THE COMPANY IS INTENDED TO CREATE AN EMPLOYMENT CONTRACT BETWEEN MYSELF AND THE COMPANY UNDER WHICH MY EMPLOYMENT COULD BE TERMINATED ONLY FOR CAUSE. ON THE CONTRARY I UNDERSTAND AND AGREE THAT, IF HIRED, MY EMPLOYMENT WILL BE TERMINABLE AT WILL AND MAY BE TERMINATED BY ME OR THE COMPANY AT ANY TIME AND FOR ANY REASON. I UNDERSTAND THAT NO PERSON HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT CONTRARY TO FOREGOING. IF EMPLOYED, I WILL BE REQUIRED TO PROVIDE ORIGINAL DOCUMENTS WHICH VERIFY MY IDENTITY AND RIGHT TO WORK IN THE UNITED STATES UNDER THE IMMIGRATION REFORM AND CONTROL ACT (IRCA) OF 1986. THE DOCUMENT(S) PROVIDED WILL BE USED FOR COMPLETION OF FORM I-9.
I HEREBY ACKNOWLEDGE THAT I HAVE READ AND AGREE TO THE ABOVE STATEMENETS.
Electronic Signature *
Date *
* Required field