Officer Construction

Rohrs Farms Employment Application

Rohrs Farms is an Equal Opportunity Employer and is committed to excellence through diversity.

Date of application: Interview Date Time

Personal Information Please Print Clearly

Name (First & Last)

Address

City

State

Zip

Phone Number

Mobile Number

Social Security Number

Driver’s License Number

State Issued

Expiration Date

How did you find out about this job? Newspaper Referral Other

If hired, do you have a reliable means of transportation to get to work? Yes No What is it?

How far away do you live from this job? Are you willing to drive that far? Yes No

Minimum salary expected Are you at least 18 years old? Yes No

Are you legally eligible for employment in the U.S.? Yes No

Have you been convicted of a felony in the last seven years? Yes No

If you answered yes to any of the previous two questions, state the nature of the offense and disposition of the case. Include dates and places. (Note: Felony convictions or the existence of a criminal record do not constitute an automatic bar to employment.)

Employment Data Please Print Clearly

Are you seeking: Temporary Full-Time Part-time

What position(s) are you applying for?

What hours are you available to work?

Are you a student? Yes No If yes, what is your class schedule?

Current Schedule: Future schedule:

Please indicate what hours you would NOT be available to work?

Are you willing to work overtime? Yes No Weekends? Yes No Holidays? Yes No

Are you currently employed? Yes No If hired, when would you be able to start?

Have you ever been discharged or asked to resign from any position? Yes No If yes, please describe:

How many days have you missed or been late to school or work within the last year other than approved vacation, sick, or approved leave of absence? Please describe:

If applicable, please refer to the job description for the position for which you are applying. Are you able to perform all these tasks with or without reasonable accommodation? Yes No Please describe which tasks, if any, you will need and accommodation to perform and explain what type of accommodation you will need:

Work History (Please list your last three employers. Begin with the most recent) Please Print Clearly

1.Company Phone No. Address City/State/Zip

Date of Employment: From To Salary: Beginning Ending

Job Title Supervisor’s Name

Describe duties briefly:

Specific reason for leaving:

2.Company Phone No. Address City/State/Zip

Date of Employment: From To Salary: Beginning Ending

Job Title Supervisor’s Name

Describe duties briefly:

Specific reason for leaving:

3.Company Phone No. Address City/State/Zip

Date of Employment: From To Salary: Beginning Ending

Job Title Supervisor’s Name

Describe duties briefly:

Specific reason for leaving:

May we contact all of the employers listed above? Yes No If no, please tell us which one(s) you do not wish us to contact and why?

How many jobs have you had in the past not listed above?

Why are you seeking a new position at this time?

List any business-related outside interests and organizations you’re active in:

Military Service Please Print Clearly

Are you a veteran? Yes No If yes, give date of service: From To

List any special skill or training

Education (Circle highest level attained) Please Print Clearly

Secondary: 9 10 11 12 GED College: 1 2 3 4 5 6 7 8

Name of School: Name of School:

Location of School: Location of School:

If currently in High School or College are you enrolled in a recognized co-op program? Yes No

If yes, identify program and school: Degree or Major:

Please read the following carefully, then sign and date the application

I authorize this company to make an investigation of all information contained in this employment application and I release from liability all companies and corporations supplying such information. I understand any false answers, statements, or implications made by me on this application or other required documents shall be considered sufficient cause for denial of employment or discharge. Upon termination of my employment for whatever reason, I release this company from all liability for supplying any information concerning my employment to any potential employer. I authorize this company, if applicable, to request a copy of my credit report, motor vehicle driving record, and any other investigative report deemed necessary through various third party sources. As required by law, upon request within a reasonable period of time, I will be notified as to the nature and scope of such investigations. I hereby agree to submit to any drug/alcohol test required of me. Whether prior to my employment or if employed by this company at any time thereafter. I understand and expressly agree that if employed by the company, storage areas provided for me (locker, desk, etc.) are open to investigation or search by the company without prior notice to me. I further understand this is an application for employment and that no employment contract is being offered. I understand that if I am employed, such employment is for an indefinite period of time and the company may change wages, benefits, and conditions at any time. My employment is at will. No individual with the company is authorized to change the employment-at-will status except the officer of the company, who may do so only in writing. I have read and understand the above.

Applicant’s Signature Date

Check over the foregoing application, making sure it is complete and signed.

Contact this candidate