Transport

Application for Employment (Transport)

EMP SERV, LLC

PO Box 370
Pipestone, MN 56164
Phone: 507-825-2532 Fax: 507-825-2205 Email: hr@pipestone.com

It is this company’s policy to provide equal opportunities in its operation and in all areas of its employment practices and to assure that there will be no discrimination against any employee or applicant for employment as provided by law. Applicants requiring accommodation in the application and/or interview process should notify a representative of the Human Resources department.

Please click the submit button only once when submitting your application.

First Name: MI: Last Name:
Address: City: State: Zip:
Home Phone: Cell Phone:    Email:

Have you previously been employed with Pipestone before?:
 Yes No
If yes, when? From: mo/year to mo/year
If no, how did you hear about Pipestone?
Referred by:
Pipestone Employee - Name :
You heard about us through a:
 Career Fair Classified Ad.
Other:

Position Applying For :
Region :
 Full Time Part Time Seasonal/Internship (check all that apply)
Available to Work:
 Days Evenings Weekends (check all that apply)
Are you willing to relocate?  Yes No
Do you have reliable transportation?  Yes No

Are you at least 16 years of age?    Yes No

Are you at least 18 years of age?    Yes No

Do you or anyone who lives in your residence have contact with swine?  Yes No

Do you or anyone you live with work with meat processing?  Yes No

EDUCATION

Name of School
City, State
Grade Completed
Graduate?
Major
 Graduate
 Graduate
 Graduate

Please state any special achievements, qualifications or experience that you may have in addition to the education listed above, which would qualify you for the position you are applying.




PREVIOUS ADDRESSES – 3yr period if different than the above address.

Street: City: State: Zip:
From: To:
Street: City: State: Zip:
From: To:
Street: City: State: Zip:
From: To:


Driver's License Information – Please list all licenses held, last 3 years:

Do you have a CDL?  Yes No

State: Number: Expiration:
State: Number: Expiration:
State: Number: Expiration:


Experience:

Type of Vehicle Driven: Miles Driven: Start Date: End Date:
Type of Vehicle Driven: Miles Driven: Start Date: End Date:
Type of Vehicle Driven: Miles Driven: Start Date: End Date:


All Accidents, past 3 years – If none, enter NONE

Date: Describe: Fatalities: Injuries:
Date: Describe: Fatalities: Injuries:
Date: Describe: Fatalities: Injuries:


Traffic Violations for the Past 3 Years – If none, write NONE

Date: Violation: State: Commercial Vehicle:  Yes No
Date: Violation: State: Commercial Vehicle:  Yes No
Date: Violation: State: Commercial Vehicle:  Yes No

Have you ever had any driver licence denied, suspended, revoked or canceled by any issuing state agency:
 Yes No

If yes, please explain:




PREVIOUS WORK EXPERIENCE – Please give 10 years of work history, starting with your most recent employer.

Company Name: City: State: Telephone:
Supervisor Name: OK to Contact:  Yes No Employment Dates: To:
Job Title: Starting Pay Rate: Ending:
Reason For Leaving:
Were you subject to the Federal Motor Carrier Safety Regulations during this period?  Yes No
Were you subject to 49 CFR part 40 controlled substance and alcohol testing during this period?  Yes No


Company Name: City: State: Telephone:
Supervisor Name: OK to Contact:  Yes No Employment Dates: To:
Job Title: Starting Pay Rate: Ending:
Reason For Leaving:
Were you subject to the Federal Motor Carrier Safety Regulations during this period?  Yes No
Were you subject to 49 CFR part 40 controlled substance and alcohol testing during this period?  Yes No


Company Name: City: State: Telephone:
Supervisor Name: OK to Contact:  Yes No Employment Dates: To:
Job Title: Starting Pay Rate: Ending:
Reason For Leaving:
Were you subject to the Federal Motor Carrier Safety Regulations during this period?  Yes No
Were you subject to 49 CFR part 40 controlled substance and alcohol testing during this period?  Yes No


Company Name: City: State: Telephone:
Supervisor Name: OK to Contact:  Yes No Employment Dates: To:
Job Title: Starting Pay Rate: Ending:
Reason For Leaving:
Were you subject to the Federal Motor Carrier Safety Regulations during this period?  Yes No
Were you subject to 49 CFR part 40 controlled substance and alcohol testing during this period?  Yes No


Company Name: City: State: Telephone:
Supervisor Name: OK to Contact:  Yes No Employment Dates: To:
Job Title: Starting Pay Rate: Ending:
Reason For Leaving:
Were you subject to the Federal Motor Carrier Safety Regulations during this period?  Yes No
Were you subject to 49 CFR part 40 controlled substance and alcohol testing during this period?  Yes No

FARM RELATED EXPERIENCE

Please read the following categories and rate your experience/knowledge level from

1 through 5. (1 = no experience; 5 = very experienced)

Transportation
 CDL License
 Pre Trip Inspections
 Air Brakes
 Combination Vehicle
 Federal Motor Carrier Safety Regulations
 Livestock Handling

Farrowing
 Supervising
 Dealing w/Work Comp
 Training
 Scheduling Work Duties
 Scheduling Employees
Computer Skills
 Microsoft Excel
 Microsoft Outlook
 Microsoft PowerPoint
 Microsoft Word
 Data Entry
 Porcitec
Certifications
 PQA Plus
 TQA Plus
 Other





For driver applicants of commercial motor vehicles that require a Commercial Drivers
License (CDL) the applicant must disclose their controlled substance and alcohol
status per the requirements of 49 CFR part 40.25(j).

As a prospective driver employee, you have the right to review information provided by previous employers. You have the right to have errors in the information corrected by the previous employer(s)and for that previous employer(s) and for that previous employer(s) to re-send the corrected information to the prospective employer; the right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information.

Driver employees who have previous Department of Transportation regulated employment history in the preceding three years, and wish to review previous employer provided investigative information, must submit a written request to the prospective employer, which may be done at anytime, including when applying or as late as thirty (30) days after being employed or being notified of denial of employment. The prospective employer must provide this information to the applicant within five (5) business days of receiving the written request. If he prospective employer has not yet received the requested information from the previous employer(s), then the five (5) business day deadlines will begin when the prospective employer receives the requested safety performance history information. If the driver has not arranged to pick up or receive the requested records within thirty (30) days of the prospective employer making them available, the prospective motor carrier may consider the driver to have waived their request to review the records.


"By signing this section of the form, I certify that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge."

Signature:    Date: 


49 CFR 40.25(j)

Have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years?




 Yes No

If YES -

Have you successfully completed the return-to-duty process?

 Yes No

If YES -

Documentation MUST BE PROVIDED before any safety-sensitive transportation is performed.

"By signing this section of the form, I certify that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge."

Signature:    Date: 




Physical Job Requirements

In order to perform the essential functions of a Swine Technician with Pipestone all applicants should be able to:

  • Stand, walk and be on feet 8 to 10 hours per day.
  • Frequently bend, reach, squat and kneel.
  • Frequently use one or both hands/arms to grasp or pull. (Employee uses power washer with 3000 psi force and 5 gallons per minute flow.)
  • Frequently lift objects weighing 3 to 20 pounds.
  • Occasional bend while pulling and/or lifting objects weighing up to 50 pounds, or requiring up to 50 pounds of force to move.
  • Occasionally bend while pulling and/or lifting objects weighing, up to 100 pounds, or requiring up to 100 pounds of force to move - with the assistance of another person as needed.
  • Please complete questions below pertaining to Physical Job Requirements.

Do you understand the essential functions? 
 Yes No

Can you perform the essential functions of this job with or without reasonable accomodation? 
 Yes No

Please list any relevant experience not listed in the Employment History Section:

REFERENCE CHECK – Please list three people who are not related to you and who are not previous employers.

Name
Email Address
(Area Code) Telephone
Occupation
Years Known

RESUME UPLOAD (optional) – If you have a resume you would like to attach you can do so here.

I certify that the answers I have provided to the questions and statements are true and correct to the best of my knowledge. I understand that any omissions, misleading statements or incorrect answers made by me may render this application void and, if employed, would be cause for termination.

All applicants should be advised that the Social Security Administration verifies the validity and authenticity of information given to Pipestone’s Human Resources and/or Payroll Departments for proof of employment eligibility. Any employee found to have presented fraudulent or falsified documents will be subject to immediate disciplinary action, up to and including termination of employment. Pipestone will provide no reimbursement, support or sponsorship for any employee found to have presented false information regarding employment eligibility.

Pipestone is an Equal Opportunity Employer.

Pre-employment drug test and background screening required.

Please click the submit button only once when submitting your application.

(You will receive email confirmation.)