Employment Application | R&F Farm Supply

Join Our Growing Company - Now Hiring!

10200 Highway 59
Erie, Kansas

620-244-3275

Employment Application

Applicant Information

First Name: *

Last Name: *

Middle Name:

Email Address: *

Phone: *

Other Phone:

Street Address: *

City: *

State: *

Zip/Postal Code: *

Contact Preference: *

Are you able to perform the essential unctions of the position with/without accomodations? Yes No

If necessary, Are you able to work overtime? Yes No

If necessary, Are you able to provide a valid Driver's License? Yes No

Are you legally eligible for employment in the U.S.? Yes No

Are you a veteran? Yes No

Are you seeking a permanent position? Yes No

Please mark which shifts you would be willing to work: Any Day Night Swing Rotating Graveyard

Upon being hired, how long until you can report to work?

Employment History

Employer Name and Address:

Start/End Dates:

Pay Rate *

Please describe your duties and any skills acquired in this position:

Please describe why you left this position:

Employer Name and Address:

Start/End Dates:

Pay Rate *

Please describe your duties and any skills acquired in this position:

Please describe why you left this position:

Employer Name and Address:

Start/End Dates:

Pay Rate *

Please describe your duties and any skills acquired in this position:

Please describe why you left this position:

Employer Name and Address:

Start/End Dates:

Pay Rate

Please describe your duties and any skills acquired in this position:

Please describe why you left this position:

Education and Qualifications

High School

Years Completed

Degree Earned

College/University

Years Completed

Degree Earned

Business/Technical or Trade School

Years Completed

Degree Earned

Please list any special skills or qualifications that you'd like to be considered for this job. This can include professional licenses, certifications, software or other equipment operating qualifications, speical abilities, and/or other honors, skills, or information pertaining to the job:

References

Reference Name

Telephone Number

Occupation

Address

Number of Years Known

Reference Name

Telephone Number

Occupation

Address

Number of Years Known

Contact

In case of emergency or accident, please list an Emergency Contact Name here:

Telephone Number

Relationship

Information For Applicants

As part of our procedure for processing your employment application, your personal and employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharges from your job. You may make a written request for information derived from the checking of your references.

If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the United States, have a physical examination and/or drug test, or to sign a conflict of interest agreement and abide by its terms. If you understand and agree to the information shown above, please finish the form by digitally signing and dating below.

Your Legal Name:

Today's Date:

For security purposes, please enter the characters from the box above:

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