Office / Plant Employment Application

All applicants are considered for all positions without regard to race, religion, color, sex, gender, sexual orientation, pregnancy, age, national origin, ancestry, physical/mental disability, medical condition, military/veteran status, genetic information, marital status, ethnicity, citizenship or immigration status or any other protected classification, in accordance with applicable federal, state, and local laws. By completing this application, you are seeking to join a team of hardworking professionals dedicated to consistently delivering outstanding service to our customers and contributing to the financial success of the organization, its clients, and its employees. Equal access to programs, services, and employment is available to all qualified persons. Those applicants requiring accommodation to complete the application and/or interview process should contact a management representative.

Position(s) Applied For*

Date of Application*

Your Personal Information

Your Name*

First Middle Last

Your Home Address*

Street Address Unit / Suite Number City State Zip Code

Main Phone Number*

Alternate Phone Number

Your Email Address*

Enter Email Confirm Email

Employment Experience

Please list the names of your present or previous employers in chronological order with present or most recent employer listed first. Be sure to account for all periods of time. If self-employed, give firm name and supply business references. Add additional rows if necessary.

Employment History

Name of Employer	Supervisor	May we contact?	Address	Phone	Dates Employed	Job Title & Duties	Reason For Leaving

Have you ever been involuntarily terminated or asked to resign from any job?*

Yes
No

If yes, please explain*

Please explain any gaps in your employment history

Other Experience & Skills

Please list any other experience, job related skills, additional languages, or other qualifications that you believe should be considered in evaluating your qualifications for employment.

Educational Background

Please describe your educational background in the space provided below.

High School

School Name	Years Completed	Diploma/Degree (Yes/No)	Area of Study/Major	Specialized Training, Skills, or Extra-Curricular Activities

College/University

School Name	Years Completed	Diploma/Degree (Yes/No)	Area of Study/Major	Specialized Training, Skills, or Extra-Curricular Activities

Graduate/Professional School

School Name	Years Completed	Diploma/Degree (Yes/No)	Area of Study/Major	Specialized Training, Skills, or Extra-Curricular Activities

Trade School

School Name	Years Completed	Diploma/Degree (Yes/No)	Area of Study/Major	Specialized Training, Skills, or Extra-Curricular Activities

Other

School Name	Years Completed	Diploma/Degree (Yes/No)	Area of Study/Major	Specialized Training, Skills, or Extra-Curricular Activities

References

Business and Professional References*

Please list three professional references of individuals who are not related to you.

Name & Title	Relationship	Phone Number or Email

Personal References*

Please list three people who know you well.

Name & Title	Relationship and Years Acquainted	Phone Number or Email

General

Have you ever worked for this company before?*

Yes
No

If yes, please give dates and position

Position	Start Date	End Date

Do you have friends and/or relatives working for this company?*

Yes
No

If yes, name(s) and relationship(s)

Name	Relationship

On what date are you available to begin work?*

Days/Hours available to work

Are you available to work?*

Full-time
Part-time
Shift Work
Temporary

If hired, would you have a reliable means of transportation to and from work?*

Yes
No

Can you travel if the position requires it?*

Yes
No

Can you relocate if the position requires it?*

Yes
No

Are you at least 18 years old?*

Note: if under 18, hire is subject to verification that you are of minimum legal age.

Yes
No

If hired, can you present evidence of your identity and legal right to work in this country?*

Yes
No

Are you able to perform the essential functions of the job for which you are applying with or without reasonable accommodation?*

Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for qualified applicants/employees to perform essential job functions.

Yes
No

Applicant Statement and Agreement

I hereby authorize Midland Farms to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the prior employers and references I have listed to disclose to Midland Farms any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release Midland Farms, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

In the event of my employment with Midland Farms, I understand that I am required to comply with all rules and regulations of the company.

If hired, I understand and agree that my employment with Midland Farms is at-will, and that neither I, nor the company is required to continue the employment relationship for any specific term. I further understand that the company or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications.

I understand that safety of employees is extremely important to Midland Farms and that the company is committed to ensuring a safe working environment. I understand that I, and every employee, have a responsibility to prevent accidents and injuries by observing all safety procedures and guidelines and following the directions of my site supervisor. I understand and agree to comply with federal, state, and local regulations related to on-the-job safety and health.

I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration laws require me to complete an I-9 Form in this regard.

I understand that if any term, provision, or portion of this Agreement is declared void or unenforceable, it shall be severed and the remainder of this Agreement shall be enforceable.

Applicant Signature*

By submitting an application online and checking the box below, I agree to the statement and terms above and it is my intent to electronically sign this record.

I Agree

Phone

This field is for validation purposes and should be left unchanged.