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Employment Application
Program, services and employment are equally available to everyone. Please inform Human Resources Department if you require reasonable accomodation for the application or interview.
Application Data
How were you referred to us:
Position applied for:
Full Name:
Application Date:
Address:
City:
State:
Zip:
Phone:
Cell Phone:
Email:
Date Available to Start:
Date of Birth:
Have you ever worked for this company?:
Yes
No
If yes, when?:
Are you legally allowed to work in the United States?:
Yes
No
Education History
Name & Location of High School:
Did you graduate?:
Yes
No
Name & Location of College:
Years attended:
Degrees completed:
Other subjects studied:
Years attended:
Subjects Studied:
Did you graduate?:
Yes
No
Summarize Your Special Skills or Qualifications
Summary:
Personal History
Residences for Last 3 Years (Begin with most recent)
Address 1:
From/To:
Address 2:
From/To:
Address 3:
From/To:
Motor Vehicle Accidents in the Last 3 Years
Date:
Nature and Circumstances of Accident:
Were there fatalities?:
Were there personal injuries?:
Date:
Nature and Circumstances of Accident:
Were there fatalities?:
Were there personal injuries?:
Violations of Motor Vehicle Laws (Other than Parking) in the Last 3 Years
Violation:
State in which it occurred:
Fine Amount $:
Violation:
State in which it occurred:
Fine Amount $:
Violation:
State in which it occurred:
Fine Amount $:
Drivers License
State of Issuance:
Expiration Date:
Type:
Class:
Endorsements:
Have you ever been denied a drivers license or had a license revoked or suspended? If "Yes" explain the facts:
List nature and extent of previous driving experience, including type of equipment (such as buses, straight trucks, tractor trailers and types of trailers):
Employment History
Dates of Employment:
Company Name:
Address:
City:
State:
Zip:
Phone:
Supervisor:
Title:
Positions(s) Held:
Responsibilities:
Was this job designated as a safety sensitive function requiring alcohol and controlled substance testing?:
Yes
No
Ending Salary:
Reason for Leaving:
Dates of Employment:
Company Name:
Address:
City:
State:
Zip:
Phone:
Supervisor:
Title:
Positions(s) Held:
Responsibilities:
Reason for Leaving:
Dates of Employment:
Company Name:
Address:
City:
State:
Zip:
Phone:
Supervisor:
Title:
Positions(s) Held:
Responsibilities:
Ending Salary:
Reason for Leaving:
Security code:
Verification
Certification:
Checking the box 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.
Maple River Grain & Agronomy
1630 1st Ave S
Casselton, ND 58012