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Orrson Custom Farming Ltd.

Employment Application

Employee Application Form

 This is  "NOT" a secure form. If you don't feel comfortable putting down certain information please contact us.

 

!!!!  ALL EMPLOYEES WILL BE SUBJECT TO RANDOM DRUG TESTING BEFORE AND DURING SEASON  !!!!

 

First Name  Middle Name   Last Name

Address

City    State    Zip 

DATE WHICH YOU CAN START WORK //

DATE WHICH YOU CAN WORK UNTIL? //

 

 

CONTACT INFORMATION

HOME PHONE #   SCHOOL/WORK   CELL PHONE #

FAX #     EMAIL ADDRESS #1   EMAIL ADDRESS #2

 

PERSONAL/MEDICAL INFORMATION

 DATE OF BIRTH 

MARITAL STATUS                COAT SIZE             SHIRT SIZE

DO YOU WEAR CORRECTIVE LENSES?                  

  DO YOU SMOKE?   

ANY IMPAIRMENTS/ DIETARY NEEDS/MEDICAL PROBLEMS THAT MAY REQUIRE SPECIAL ATTENTION?    If yes please explain

Note: This question is optional and will be kept confidential

ARE YOU ON ANY MEDICATIONS?     If yes please list

HAVE YOU EVER BEEN ARRESTED?    If so what were you convicted of? 

 

 

  PHYSICIAN INFORMATION

 PHYSICIANS NAME    

ADDRESS

PHONE NUMBER OF CLINIC

 

   EMERGENCY CONTACT

NAME    ADDRESS

PHONE NUMBER     RELATION

 

   EDUCATION INFORMATION

HIGH SCHOOL NAME    DID YOU GRADUATE? 

    COLLEGE / MAJOR

 

   DRIVER INFORMATION   

(PLEASE SEND A PHOTO COPY OR A SCAN OF YOUR DRIVERS LICENSE TO US FOR OUR RECORDS EITHER BY FAX, MAIL, OR EMAIL)

DRIVERS LICENSE NUMBER    EXPIRATION DATE

STATE     CLASS OF LICENSE   

  ENDORSEMENTS

  RESTRICTIONS 

DOT HEALTH CARD                         HAVE YOU EVER BEEN CHARGED WITH DWI OR DUI?

ANY VIOLATIONS OR OUTSTANDING TICKETS IN THE PAST 5 YEARS?     

If yes please list violations

IF YOU DON'T CURRENTLY POSSES A VALID COMMERCIAL DRIVERS LICENSE WOULD YOU BE WILLING AND ABLE TO OBTAIN ONE? 

 

 PREVIOUS EMPLOYER INFORMATION 

IF YOU HAVE NO PREVIOUS EMPLOYERS PLEASE LIST A MINIMUM OF 3 CREDITABLE REFERENCES

 ARE YOU CURRENTLY EMPLOYED 

 

 NAME OF COMPANY

ADDRESS

CITY   State    PHONE NUMBER

SUPERVISOR     DATES OF EMPLOYMENT  until

WORK DESCRIPTION OR COMMENTS ON THIS EMPLOYER 

 

NAME OF COMPANY

ADDRESS

CITY   State    PHONE NUMBER

SUPERVISOR     DATES OF EMPLOYMENT  until

WORK DESCRIPTION OR COMMENTS ON THIS EMPLOYER 

 

NAME OF COMPANY

ADDRESS

CITY   State     PHONE NUMBER

SUPERVISOR     DATES OF EMPLOYMENT  until

WORK DESCRIPTION OR COMMENTS ON THIS EMPLOYER 

 

 EXPERIENCE / SKILLS

  TYPES OF TRUCK(S) OPERATED ALONG WITH TRANSMISSIONS  

 

 

TYPES OF COMBINES OPERATED

 

 

 

TYPES OF TRACTORS OPERATED

 

 

 

LIST OTHER RELATED SKILLS

 

 

 

 

 

PLEASE FEEL FREE TO SEND ANY ADDITIONAL INFORMATION YOU FEEL MAY BE BENEFICIAL TO US AT  or to the address/fax number listed above

 

NOTE: All information on this application will be kept confidential.

 

 

 

By signing below you give us permission to further research the information contained on this application and understand that misinformation or false statements listed could result in your dismissal.

 

(if applying online a typed signature will be sufficient)

 

signature

 

 You may also print out this form and mail it to us at

Orrson Custom Farming LLC

9293 Lautenschlager Rd.

Apple Creek, OH   44606

 

 

 

 

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