Discount Grain Systems

Online Application For Employment
 (type in the boxes and submit)

PERSONAL INFORMATION   

Name:    

Social Security Number: 

Present Address 

How long have you lived at this address? 

Phone Number:           Are you 18 years or older?

Driver's License Number: 

Are you a US Citizen or an alien authorized to work in the United States? 

Have you ever been convicted of a crime?

Are there any felony charges pending against you? 

Names of any relatives working for this company:

Names of any acquaintances currently working for this company: 

EMPLOYMENT DESIRED
 

Position:           Date you can start: 

Salary desired:     Are you currently employed?

May we inquire of present employer?

How did you hear about this position?

RELATED EXPERIENCE

Do you have experience in any of the following areas (check ALL that apply)

                       Grain Handling Equipment                               Grain Storage Equipment                            Concrete work                   
                       Millwright                                                       Heavy Equipment Operator                         Welding
                       General Construction                                      Supervisory Position                                    Mechanical

Briefly describe any other skills or experiences you feel will qualify you for this position:

Do you have any health problems that would prevent you from doing certain types of
Manual labor?
If yes, please describe: 

FORMER EMPLOYERS (List last three employers, starting with last on first)

Name of employer:        Salary: 

Position:    (month & year) From & To: 

Reason for leaving: 

Name of employer:        Salary: 

Position:    (month & year) From & To: 

Reason for leaving: 

Name of employer:        Salary: 

Position:    (month & year) From & To: 

Reason for leaving: 

REFERENCES

Name:   Occupation:    Years Known: 

Name:   Occupation:    Years Known: 

Name:   Occupation:    Years Known: