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Employment Application McLeod Farms

Applicant Information
Full Name: Date:
Last First M.I.

Address:
Street Address Apartment/Unit #

City State ZIP Code

Phone: DOB: Email:

Date Available: Social Security No.: xxx-xx-xxxx Driver’s License No:

Position Applied for:


YES NO YES NO
Are you a citizen of the United States? If no, are you authorized to work in the U.S.?
YES NO
Have you ever worked for this company? If yes, when?
YES NO
Have you ever been convicted of a felony? If yes, explain.: __________________________________

Education
High School: Address:
YES NO
From: To: Did you graduate?

College: Address:
YES NO
From: To: Did you graduate? Degree:

Other: Address:
YES NO
From: To: Did you graduate? Degree:

References
Please list three professional or personal references.

Full Name: Relationship:


Company: Phone:
Address:

Full Name: Relationship:


Company: Phone:
Address:

Full Name: Relationship:


Company: Phone:
Address:

1
Previous Employment
Company: Phone:
Address: Job Title:

Responsibilities:

From: To: Reason for Leaving:


YES NO
May we contact your previous supervisor for a reference?

Company: Phone:
Address: Job Title:

Responsibilities:

From: To: Reason for Leaving:


YES NO
May we contact your previous supervisor for a reference?

Company: Phone:
Address: Job Title:

Responsibilities:

From: To: Reason for Leaving:


YES NO
May we contact your previous supervisor for a reference?

Additional Information
Expected Wages: _________________
Do you have any scheduled absences which would require you to miss work in the next 6 months? Please list dates:
_______________________________________________________________________________________________
YES NO
Are you physically able to lift 50-75 pounds consistently?
YES NO
Are you physically able to bend, stoop, kneel, and stand on your feet for long periods of time?
YES NO
Are you willing to work outdoors in adverse weather conditions?
YES NO
Do you have reliable transportation to and from work everyday?
YES NO
Do you agree to random drug testing?
YES NO
May we have access to your records through the local law enforcement agency?

Disclaimer and Signature


I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.

Signature: Date:

Under Federal law, agricultural work is exempt from overtime pay. Applicants must provide a valid driver’s license or
alternative valid photo ID and social security card as proof of identity. Identity will be verified electronically.