Applicant Information

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Last Name:

First Name:

Middle Initial:

Date:

Street Address:

City:

State:

ZIP Code:

Telephone Number:

Email Address:

Date Available:

Social Security Number:

Desired Salary:

Position Applied for:

Location:
LuverneYankton

Are you authorized to work in the U.S.?
YesNo

Have you ever worked for this company?
YesNo

If yes, when?

Education

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High School:

City / State:

Number of Years Completed:
1234

Diploma:
YesNo

College:

Address:

From:

To:

Did you graduate?
YesNo

Degree:

Other:

Address:

From:

To:

Did you graduate?
YesNo

Degree:

References

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Please list three professional references:

First Reference
Full Name:

Relationship:

Company:

Phone:

Address:

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Second Reference
Full Name:

Relationship:

Company:

Phone:

Address:

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Third Reference
Full Name:

Relationship:

Company:

Phone:

Address:

Previous Employment
List most recent first.
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First Company:

Phone:

Address:

Supervisor:

Job Title:

Responsibilities:

From:

To:

Reason for leaving:

May we contact your previous supervisor for a reference?
YesNo

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Second Company:

Phone:

Address:

Supervisor:

Job Title:

Responsibilities:

From:

To:

Reason for leaving:

May we contact your previous supervisor for a reference?
YesNo

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Third Company:

Phone:

Address:

Supervisor:

Job Title:

Responsibilities:

From:

To:

Reason for leaving:

May we contact your previous supervisor for a reference?
YesNo

Military Service
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Branch:

From:

To:

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

Disclaimer and Signature
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I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize Great Plains Processing to verify their accuracy and to obtain reference information on my work performance. I hereby release Great Plains Processing from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information.
I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal.
I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of the Employer. However, I further understand that neither the policies, rules, regulations of employment or anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration and at will and that either I or the Employer may terminate my employment at any time with or without notice or cause.
I understand that final confirmation of any job offer will be contingent upon my undergoing a pre-employment drug screening, and that failure to submit to such screening, the falsification of a screen, or a positive finding on a test will remove me from consideration for employment for one year. I consent to the screening and will report for screening on the day assigned by Great Plains Processing. I understand that upon acceptance of a job offer I will be subject to a background screen.

I have read and understand the terms listed above.

Digital Signature (Type your full name)

Date:


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