Witmer's Feed & Grain | General Employment Application

Witmer’s Feed and Grain, Inc., is an equal opportunity employer. In compliance with Federal and State Equal Employment Laws, qualified applicants are considered for all positions without regard to race, color, religion, national origin, sex, age, marital status, veteran status, non-job related physical or mental disability or any other protected group.

Today's Date*

Personal Information

First Name*

Last Name*

Email*

Phone No.*

Referred By

Desired Position

Most Production/Maintenance/Driver positions require frequent lifting. Can you lift 50 lbs. bags on a constant basis?

Yes

Current Address

Address*

City*

State*

Zip Code*

Drivers Only

Date of Birth

Driver’s License No.

Issuing State

Date Available

Are You Currently Employed?

Yes

If so may we inquire with your present employer?

Yes

Type of Employment

Yes

Have you ever applied to or been employed by Witmer’s before?

Yes

Education

High School

Name

Location

Years

Graduated?

Yes

Major

College/Trade School

Name

Location

Years

Graduated?

Yes

Major

Other School

Name

Location

Years

Graduated?

Yes

Major

Employment History

Current Employer

Name

Address

Employed From

Employed Until

Position Held

Most Recent Wage

May we contact your employer?

Yes

Reason for leaving

Previous Employer

Name

Address

Employed From

Employed Until

Position Held

Most Recent Wage

May we contact your employer?

Yes

Reason for leaving

Previous Employer

Name

Address

Employed From

Employed Until

Position Held

Most Recent Wage

May we contact your employer?

Yes

Reason for leaving

References

Name

Address or Phone

Occupation

Years Known

PERSONAL STATEMENTS

Do you have any agriculture background or experience? If so, please list

What skills or work experience do you have? Please list

Please state why you would be an asset to Witmer’s Feed & Grain as an employee

TO BE READ AND AUTHORIZED BY APPLICANT

By checking the boxes below you agree to the following:

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

Under the provisions of the Fair Credit Reporting Act, 15 UFC, SECTION 1681 ET SEQ, The Americans with Disabilities Act and all applicable Federal, State, and Local laws, I hereby authorize and permit Witmer’s Feed and Grain, Inc. to obtain a consumer report and/or an investigative consumer report which may include the following: (1) My Employment Records; (2) Records concerning any driving, criminal history, credit history, civil records, Worker’s Compensation and drug testing; (3) (For Truck Drivers Only) In accordance with the Department of Transportation Motor Carrier Safety Regulations, Section 382.413, information concerning alcohol and controlled substances for the last 3 years; (4) Verification of my academic and/or professional credentials; and information and/or copies of documents from any military service records.

I understand that an ‘Investigative Consumer Report’ may include information as to my character, general reputation, personal characteristics, and mode of living which may be obtained by interviews with individuals with whom I am acquainted or who may have knowledge concerning any such items of information. I agree that a copy of the authorization has the same effect as an original. I hereby release and hold harmless any person, firm, or entity that discloses matters in accordance with this authorization, as well as Witmer’s Feed & Grain, Inc., from liability that might otherwise result from the request for use and/or disclosure of any or all of the foregoing information.

I understand and acknowledge that under provision of the Fair Credit Reporting Act I may request a copy of any consumer report from the consumer reporting agency that complied report, after I have provided proper identification. I hereby authorize Witmer’s Feed & Grain, Inc., to obtain and prepare an investigative consumer report as set forth above, as part of its investigation of my employment application. This authorization shall remain in effect over the course of my employment. Reports may be ordered periodically during the course of my employment.

Disclosure

As part of our hiring background and investigation, we may obtain consumer reports to prepare an investigative consumer report. The investigative consumer report may consist of contacting all listed prior employers to verify your employment history. It may also include, but not be limited to, credit information reports, criminal history reports and driving records. Under the provisions of the Fair Credit Reporting Act (15 USC at 1681-1681U) as amended, before we can seek such reports, we must have your written permission to obtain information. You have the right, upon written request, to a complete and accurate disclosure of the nature and scope of the investigation. You are also entitled to a copy of your rights under the Fair Credit and Reporting Act.

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