CRI Job Application

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Home > CRI Job Application	Print Page E-mail Page

Application for Employment:

Fields marked with an asterisk (*)
are required fields.

Cooperative Resources International is an Equal Opportunity Employer. The Employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state, or federal law.
Date of Application: September 2, 2010
Attach your resume(one file):
Attach another file:

General

*Last Name:		*First Name:
Middle Name:		*Email Address:
*Street Address:		*City:
*County:		*State:
*Zip Code:
*Telephone Day:		*Telephone Evening:
	Other names you have gone by:

If you are under 18, can you furnish a work permit?	Yes No
Have you ever been employed here before? (Job title, duties, and location)	Yes No If yes, in what capacity?
Are you legally eligible for employment in the United States? (If offered employment, you will be required to provide documentation to verify eligibility and identity.)	Yes No
Have you been convicted of a felony in the last seven (7) years? (A criminal conviction will be considered only in relation to the job for which you are applying. It does not bar you from employment.)	Yes No If yes, please explain:

Position

*Position(s) applying for (be specific):	Date available for work:
Type of employment desired:	Full-Time Regular Part-Time Regular Temporary Seasonal Educational Intern
	Days	Hours ex. 8am-5pm
	Mon.
	Tues.
	Wed.
Days/Hours available for work (check all that apply):	Thurs.
	Fri.
	Sat.
	Sun.
	No Preference
Do you object to working on Saturdays and Sundays?	Yes No
If hired, would you be able to travel or work overtime as needed?	Yes No

Employment History (List your work experience beginning with your most recent job held. Include U.S. Military Service.)

Employer Name:		From (Mo./Yr.): To (Mo./Yr.):
Address (City, State, Zip):		Telephone:
Your Position Title:		Supervisor's Name/Title:
May we contact this employer? Yes No		Starting Pay: $ per
		Finish Pay: $ per
Summarize the nature of work performed, job responsibilities, skills:

Reason for leaving (be specific):

Employer Name:		From (Mo./Yr.): To (Mo./Yr.):
Address (City, State, Zip):		Telephone:
Your Position Title:		Supervisor's Name/Title:
May we contact this employer? Yes No		Starting Pay: $ per
		Finish Pay: $ per
Summarize the nature of work performed, job responsibilities, skills:

Reason for leaving (be specific):

Employer Name:		From (Mo./Yr.): To (Mo./Yr.):
Address (City, State, Zip):		Telephone:
Your Position Title:		Supervisor's Name/Title:
May we contact this employer? Yes No		Starting Pay: $ per
		Finish Pay: $ per
Summarize the nature of work performed, job responsibilities, skills:

Reason for leaving (be specific):

Education & Training

High School (Name, City, State):
Course of Study:
Did you graduate?	Yes No
Years Completed:
Diploma or Degree Received:

College/University (Name, City, State):
Course of Study:
Did you graduate?	Yes No
Years Completed:
Diploma or Degree Received:

Business/Technical/Trade (Name, City, State):
Course of Study:
Did you graduate?	Yes No
Years Completed:
Diploma or Degree Received:

Other (Name, City, State):
Course of Study:
Did you graduate?	Yes No
Years Completed:
Diploma or Degree Received:

Professional licenses, certificates or registrations:

Additional education, training, skills or information to describe your qualifications for the position for which you are applying:

Do you belong to any professional, trade, business or civic associations that deal with the position for which you are applying? (Exclude memberships which would reveal sex, race, religion, national origin, age, color, disability or other protected status.) Please explain and list offices held:	Yes No

Experience

Do you have agricultural experience? Yes No Please describe:

Additional Information

Do you have a reliable means of transportation?	Yes No
Do you have a valid driver's license?	Yes No
Driver License Number:
State:
Type:	Operator Commercial (CDL) Chauffeur
Has your driver's license ever been suspended or revoked?	Yes No
Have you had a moving traffic violation within the past three years?	Yes No If yes, how many?
Have you had any accidents within the past three years?	Yes No
Are you willing to relocate?	Yes No

References (List three professional or personal references other than relatives.)

Name:	Address:
Position:	Company:
Telephone:	How acquainted?

Name:	Address:
Position:	Company:
Telephone:	How acquainted?

Name:	Address:
Position:	Company:
Telephone:	How acquainted?

Applicant's Certification and Agreement (Application must be signed.)

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 the Employer to verify their accuracy and to obtain reference information about me regarding work performance. I hereby release the Employer and its representatives from any/all liability of whatever kind of nature which, at any time, could result from obtaining and having an employment decision based on such information. I also release any/all other persons, corporations, or organizations for furnishing such information.

It is understood and agreed upon that any misrepresentation, false statements of any kind, or omissions of facts by me as called for in this application will be sufficient cause for cancellation of this application and/or separation from the employer's service if I have been employed.

All employees are considered "employees at will" with no offer or guarantee of continued employment. Furthermore, I understand that just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time, with or without cause, and without prior notice. I understand that no representative of the employer has the authority to make any assurances to the contrary.

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.

*Signature of Applicant:

*Date:

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