Employment Application

Personal Data

Name

Phone (mobile/home)

Current Address (Street, Apartment, City, State, Zip)

Email

Social Security Number

Date available to work

Expected Wage

Referred By

Position for which you are applying

Are you at least 18 years of age?
Yes No

Can you provide proof, if hired, that you are eligible to work in the United States?
Yes No

Do you have a valid driver’s license?
Yes No

Have you ever been convicted of a felony?
Yes No

Applicant's Education

High School (Name, Address , Major/Minor, Grade Completed, Degree/Diploma)

College (Name, Address , Major/Minor, Grade Completed, Degree/Diploma)

Technical (Name, Address , Major/Minor, Grade Completed, Degree/Diploma)

Other Professional Achievements

Licenses (Type, Identification, Year Completed)

Certificates (Type, Identification, Year Completed)

Other (Specify)

List all field/heavy/light equipment operated

Employment Record 1

Company Name and Address

Date of Employment Start

Date of Employment End

Rate of Pay

Job Title

Supervisor's Name

Duties

Reason for Leaving

Employment Record 2

Company Name and Address

Date of Employment Start

Date of Employment End

Rate of Pay

Job Title

Supervisor's Name

Duties

Reason for Leaving

Employment Record 3

Company Name and Address

Date of Employment Start

Date of Employment End

Rate of Pay

Job Title

Supervisor's Name

Duties

Reason for Leaving

Employment Record 4

Company Name and Address

Date of Employment Start

Date of Employment End

Rate of Pay

Job Title

Supervisor's Name

Duties

Reason for Leaving

Reference 1 (Other than family or employers)

Name

Address

Phone

Reference 2 (Other than family or employers)

Name

Address

Phone

Reference 3 (Other than family or employers)

Name

Address

Phone

Policy

I understand that all information on this application is subject to verification and that Dakota Blenders, LLC. will thoroughly investigate my work and personal history and verify all data given on this application, on related papers, and in interviews. By my signature below, I consent to criminal and credit history background checks. I also authorize all individuals, schools, businesses, employers (past and present), and references herein, except my current employer if so noted, to provide any information requested about me, and I release them from all liability for damage in providing this information. I further authorize Dakota Blenders, LLC. to rely upon and use, as it sees fit, any information received from such contacts and background checks. I further understand that employment is “at-will” and that nothing contained in this employment application or statements made during the interview process if an interview is granted, is intended to create an employment contract between Dakota Blenders, LLC. and myself for either employment or for the providing of any benefit. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon Dakota Blenders, LLC. unless made in writing. Other than the President of Dakota Blenders, LLC. , no supervisor, manager, or other person, irrespective of title or position, has authority to alter the “at-will” status of your employment or to enter into any employment contract for a definite period of time with you. Any agreement with you altering your “at-will” employment status must be in writhing and signed by the president of Dakota Blenders, LLC. I also understand that Dakota Blenders, LLC. requires pre-employment drug and alcohol testing. No prospective employee will be asked to submit to drug and alcohol testing unless an offer of employment has been made. An offer of employment is conditioned on the prospective employee testing negative for illegal drugs and alcohol. I understand and agree to submit to the required pre-employment drug and alcohol testing if an offer of employment is made to me.

I certify that all the statements herein are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal of employment.
Yes No

Date Completed

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