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Application to CFE

First Name

Last Name

Have you ever applied to this company before?

If yes, when?

What work schedule are you seeking?

From what specific source did you first learn of this position?

First Name

Middle Name

Last Name

Email Address

Phone Number

Address

City

State

Zipcode

Are you 18 years of age or older?

If hired, you will be required to furnish proof that you are legally authorized to work in the United States.

Are you able to perform the essential duties of the job(s) for which you are applying, as described, with or without reasonable accommodation?

Have you ever been convicted of any crime as an adult (excluding traffic violations other than felonies)?

A conviction includes a plea, verdict, or finding of guilt, regardless of whether sentence is imposed by the court. A criminal conviction will not necessarily disqualify an applicant from employment.

If yes, please explain:

Do you have any relatives working for this organization?

If yes, please provide name, department for which the individual works, and your relationship to them.

Employment History

Name of Employer (Most Recent)

Phone Number

Starting Date

Ending Date

Name of Immediate Supervisor

Title of Immediate Supervisor

Address

City

State

Zipcode

Your Title

Starting Salary

Ending Salary

Your Duties

Reason for leaving?

May we contact this employer?

Name of Employer (Next Recent)

Phone Number

Starting Date

Ending Date

Name of Immediate Supervisor

Title of Immediate Supervisor

Address

City

State

Zipcode

Your Title

Starting Salary

Ending Salary

Your Duties

Reason for leaving?

May we contact this employer?

Name of Employer (Next Recent)

Phone Number

Starting Date

Ending Date

Name of Immediate Supervisor

Title of Immediate Supervisor

Address

City

State

Zipcode

Your Title

Starting Salary

Ending Salary

Your Duties

Reason for leaving?

May we contact this employer?

Education

Please complete for all that apply.

High School Level

High School Name

City/State

College Level

College Name

City/State

Field of Study / Degree(s)

Additional Education Notes

References

Please provide at least three professional references.

Name

Company

Title

Phone / Email

Name

Company

Title

Phone / Email

Name

Company

Title

Phone / Email

Name

Company

Title

Phone / Email

Applicant Statement

I certify that the answers given in this application are true and correct and that I have not withheld any facts or circumstances. I understand that all answers given on my application for employment are subject to verification. I understand that if I’m employed by Cooperative Farmers Elevator, any false statement, misrepresentation, or omission of facts on this application of employment or on any supporting documents, regardless of when discovered to be false or omitted, may be sufficient reason for immediate dismissal.

I understand that the information provided in my application for employment will be verified, including academic background, employment history, and any criminal convictions which may be on my record. I give Cooperative Farmers Elevator consent to conduct a background and criminal record check. I also authorize my past employers and schools to give to Cooperative Farmers Elevator pertinent information about me. I also understand that all offers of employment are contingent upon verification of the information provided in my application of employment.

BY CHECKING THE BOX AND SIGNING MY NAME BELOW, I CONFIRM THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE, AS WELL AS ALL TERMS, LATE CHARGES AND LEGAL CONDITIONS CONTAINED HEREIN.

Type Full Name Here to Sign "Applicant Statement"

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