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Farmers Union

1913 County Road B32
Ossian, IA 52161

888-211-8910
563-532-9381

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APPLICATION INFORMATION

*First Name:

*Last Name:

*Middle Initial:

Street Address:

Apartment/Unit #:

City:

State:

ZIP:

*Phone:

*Email:

*Position Applying for:

*Date Available:

Desired Salary:

*Are you a citizen of the United States?

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If no, are you authorized to work in the U.S?

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*Have you ever worked for this company?

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If yes, when?

Have you ever been convicted of a felony?

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If yes, explain:

EDUCATION

High School:

Address:

From:

To:

Did you graduate?

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College:

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Did you graduate?

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Degree:

Other Education:

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To:

Did you graduate?

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Degree:

REFERENCES

Please list three professional references

Full Name:

Relationship:

Company:

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Address:

Full Name:

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Full Name:

Relationship:

Company:

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Address:

PREVIOUS EMPLOYMENT

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary $:

Ending Salary $:

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes No

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary $:

Ending Salary $:

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes No

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary $:

Ending Salary $:

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes No

MILITARY SERVICE

Branch:

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To:

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

DISCLAIMER AND SIGNATURE

Certify that your answers are true and complete to the best of your knowledge

Yes

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release

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1913 County Road B32
Ossian, IA 52161
888-211-8910
563-532-9381

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