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Attebury Application For Employment
Step 1 of 6
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APPLICANT INFORMATION
Name
*
First
Middle
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Social Security Number
*
Phone
*
Alternate Phone
Email
*
Position Applied For
*
Date Available
*
Desired Salary
*
Type Of Employment
*
Full Time
Part Time
Seasonal
Summer
If you cannot work full time, please explain:
Are you able to perform the essential functions of the position for which you are applying with or without accommodations?
*
YES
NO
If no, please explain. (If you have any question as to what functions are applicable to the position for which you are applying, please ask the interviewer before you answer this question.)
Are you available to work:
*
Days
Nights
Weekends
Days and Hours Available:
Sunday
*
Monday
*
Tuesday
*
Wednesday
Thursday
*
Friday
*
Saturday
*
ATTEBURY IS AN EQUAL OPPORTUNITY EMPLOYER, DEDICATED TO A POLICY OF NON-DISCRIMINATION IN EMPLOYMENT ON ANY BASIS INCLUDING RACE, AGE, GENDER, RELIGION, COLOR, CREED, ANCESTRY, SET, MARITAL STATUS, VETERANS STATUS, DISABILITY OR NATIONAL ORIGIN.
Are you currently employed?
*
YES
NO
May we contact?
*
YES
NO
N/A
If currently employed, why are you considering leaving? Have you ever applied with this company?
*
Do you have any relatives or friends who work for the Company?
*
YES
NO
If yes, who and where do they work?
*
How did you hear about us?
*
Walk-In
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Other
Are you a citizen of the United States?
*
YES
NO
If no, are you legally authorized to work in the U.S.? (Proof of identity and eligibility will be required upon employment)
*
YES
NO
Have you ever been convicted of a felony which resulted in imprisonment within the last seven years?
*
YES
NO
If yes, please explain:
*
(A conviction will not automatically disqualify you for employment. Rather, such factors as age and date of conviction, seriousness and nature of the crime, and rehabilitation will be considered).
EDUCATION
High School
Location
Did you graduate and when?
College
Location
Did you graduate and when?
Graduate Level
Location
Did you graduate and when?
Trade School
Location
Did you graduate and when?
ATTEBURY IS AN EQUAL OPPORTUNITY EMPLOYER, DEDICATED TO A POLICY OF NON-DISCRIMINATION IN EMPLOYMENT ON ANY BASIS INCLUDING RACE, AGE, GENDER, RELIGION, COLOR, CREED, ANCESTRY, SET, MARITAL STATUS, VETERANS STATUS, DISABILITY OR NATIONAL ORIGIN.
Experience/Skills related to the position for which you are applying:
Skill/Attitude
Words Per Minute
Software Used
Skill/Attitude
Years Experience
Years Experience
Words Per Minute
Software Used
Skill/Attitude
Years Experience
Words Per Minute
Software Used
List training courses completed and any other training which may be helpful in considering your application.
EMPLOYMENT HISTORY
Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration. Add a separate page if necessary.
COMPANY, PHONE, ADDRESS, SUPERVISOR, JOB TITLE, STARTING SALARY, ENDING SALARY, RESPONSIBILITIES, START DATE, END DATE, 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, START DATE, END DATE, 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, START DATE, END DATE, 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, START DATE, END DATE, 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, START DATE, END DATE, REASON FOR LEAVING.
May we contact your previous supervisor for a reference?
YES
NO
ATTEBURY IS AN EQUAL OPPORTUNITY EMPLOYER, DEDICATED TO A POLICY OF NON-DISCRIMINATION IN EMPLOYMENT ON ANY BASIS INCLUDING RACE, AGE, GENDER, RELIGION, COLOR, CREED, ANCESTRY, SET, MARITAL STATUS, VETERANS STATUS, DISABILITY OR NATIONAL ORIGIN.
COMPANY, PHONE, ADDRESS, SUPERVISOR, JOB TITLE, STARTING SALARY, ENDING SALARY, RESPONSIBILITIES, START DATE, END DATE, 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, START DATE, END DATE, REASON FOR LEAVING.
May we contact your previous supervisor for a reference?
YES
NO
Have you ever been discharged or asked to resign from a job?
*
YES
NO
If yes, please explain:
*
Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for?
*
YES
NO
If yes, please explain:
*
ATTEBURY IS AN EQUAL OPPORTUNITY EMPLOYER, DEDICATED TO A POLICY OF NON-DISCRIMINATION IN EMPLOYMENT ON ANY BASIS INCLUDING RACE, AGE, GENDER, RELIGION, COLOR, CREED, ANCESTRY, SET, MARITAL STATUS, VETERANS STATUS, DISABILITY OR NATIONAL ORIGIN.
REFERENCES
FULL NAME, RELATIONSHIP (LANGUAGE SPOKE), COMPANY, PHONE, ADDRESS, EMAIL
FULL NAME, RELATIONSHIP (LANGUAGE SPOKE), COMPANY, PHONE, ADDRESS, EMAIL
FULL NAME, RELATIONSHIP (LANGUAGE SPOKE), COMPANY, PHONE, ADDRESS, EMAIL
APPLICANT’S CERTIFICATION AND AGREEMENT
PLEASE READ VERY CAREFULLY
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 Attebury Grain, LLC to verify their accuracy and to obtain reference information on my work performance. I, hereby release Attebury Grain, LLC 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 may disqualify me from further consideration for employment and shall be considered sufficient basis for dismissal if determined at a later date.
I authorize you to communicate with persons listed as references, former employers, and any others with whom you desire to check. I agree to hold such persons harmless with respect to any information they may give about me.
In consideration of my employment, if I am employed, I agree to conform to the employment policies and rules of the Company. I understand that my employment and compensation can be terminated, with or without notice, at any time, at the option of either the Company or myself. I understand that no representative of the Company, other than the Managing Director, has the authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing. I further understand that neither the policies, rules, regulations of employment nor anything said during the interview process shall be deemed to constitute the terms of an implied employment contract.
If employed, I agree to engage in no outside activity which would involve a material conflict of interest with, or which could reflect adversely on the Company. I understand this decision is to rest with the Company.
I understand that the Company requires the successful completion of a urinalysis for drug testing purposes and/or a blood alcohol test as a condition of employment. By submitting this Application for Employment, I hereby consent to either or both of said tests, at the Company's discretion. This application for employment is good for 30 days. Consideration for employment after 30 days requires a new application.
Signature
*
Date
*
Date Format: MM slash DD slash YYYY
ATTEBURY IS AN EQUAL OPPORTUNITY EMPLOYER, DEDICATED TO A POLICY OF NON-DISCRIMINATION IN EMPLOYMENT ON ANY BASIS INCLUDING RACE, AGE, GENDER, RELIGION, COLOR, CREED, ANCESTRY, SET, MARITAL STATUS, VETERANS STATUS, DISABILITY OR NATIONAL ORIGIN.
ATTEBURY IS AN EQUAL OPPORTUNITY EMPLOYER, DEDICATED TO A POLICY OF NON-DISCRIMINATION IN EMPLOYMENT ON ANY BASIS INCLUDING RACE, AGE, GENDER, RELIGION, COLOR, CREED, ANCESTRY, SET, MARITAL STATUS, VETERANS STATUS, DISABILITY OR NATIONAL ORIGIN.