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First
Name Middle Name Last Name |
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Address
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City
State
Zip |
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DATE WHICH YOU
CAN START WORK // |
DATE WHICH YOU
CAN WORK UNTIL? // |
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CONTACT
INFORMATION |
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HOME PHONE #
SCHOOL/WORK
CELL PHONE # |
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FAX #
EMAIL ADDRESS #1 EMAIL ADDRESS #2 |
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PERSONAL/MEDICAL
INFORMATION |
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DATE OF
BIRTH |
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MARITAL STATUS
COAT SIZE
SHIRT SIZE |
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DO YOU WEAR
CORRECTIVE LENSES?
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DO YOU
SMOKE? |
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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
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ARE YOU ON ANY
MEDICATIONS? If yes please list
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HAVE YOU EVER
BEEN ARRESTED?
If so what were you convicted of? |
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PHYSICIAN
INFORMATION |
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PHYSICIANS
NAME
ADDRESS
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PHONE NUMBER OF
CLINIC |
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EMERGENCY
CONTACT |
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NAME
ADDRESS
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PHONE NUMBER
RELATION |
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EDUCATION
INFORMATION |
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HIGH SCHOOL
NAME DID YOU GRADUATE? |
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COLLEGE / MAJOR
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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) |
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DRIVERS LICENSE
NUMBER EXPIRATION DATE
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STATE
CLASS OF LICENSE
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ENDORSEMENTS
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RESTRICTIONS
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DOT HEALTH CARD
HAVE YOU EVER BEEN CHARGED WITH DWI OR DUI? |
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ANY VIOLATIONS OR
OUTSTANDING TICKETS IN THE PAST 5 YEARS?
If yes please
list violations |
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IF YOU DON'T
CURRENTLY POSSES A VALID COMMERCIAL DRIVERS LICENSE WOULD YOU BE WILLING
AND ABLE TO OBTAIN ONE? |
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PREVIOUS
EMPLOYER INFORMATION
IF YOU HAVE NO PREVIOUS EMPLOYERS PLEASE LIST A
MINIMUM
OF 3 CREDITABLE REFERENCES |
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ARE YOU
CURRENTLY EMPLOYED |
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NAME OF
COMPANY |
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ADDRESS
CITY State
PHONE NUMBER
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SUPERVISOR
DATES OF EMPLOYMENT until
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WORK DESCRIPTION
OR COMMENTS ON THIS EMPLOYER
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NAME OF
COMPANY |
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ADDRESS
CITY State
PHONE NUMBER
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SUPERVISOR
DATES OF EMPLOYMENT until
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WORK DESCRIPTION
OR COMMENTS ON THIS EMPLOYER
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NAME OF
COMPANY |
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ADDRESS
CITY State
PHONE NUMBER |
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SUPERVISOR
DATES OF EMPLOYMENT until
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WORK DESCRIPTION
OR COMMENTS ON THIS EMPLOYER
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EXPERIENCE
/ SKILLS |
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WHICH POSITION
WOULD YOU PREFER? select as many as you prefer
TRUCK DRIVER COMBINE OPERATOR GRAIN CART OPERATOR NO PREFERENCE
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TYPES OF
TRUCK(S) OPERATED ALONG WITH TRANSMISSIONS
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TYPES OF
COMBINES OPERATED |
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TYPES OF
TRACTORS OPERATED |
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LIST OTHER
RELATED SKILLS |
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PLEASE FEEL
FREE TO SEND ANY ADDITIONAL INFORMATION YOU FEEL MAY BE BENEFICIAL
TO US AT
employment@johnsonharvesting.com
or to the address/fax number listed above |
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NOTE: All
information on this application will be kept
confidential. |
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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. |
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(if applying
online a typed signature will be sufficient) |
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signature
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You may also print out this form and mail it to
us @ Johnson Harvesting Inc. 22082 Co Rd 8 NW Evansville, MN
56326 or fax it to 320/834-4785 |
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Copyright © 2003-2008
Johnson Harvesting Inc. All rights reserved
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