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JOB APPLICATION
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 reasonable accommodation in the application and/or interview process should notify a representative of the Human Resources department.
Position for which you are applying:
PERSONAL
Last Name:
First Name:
Middle Name:
Address:
City:
State:
ZIP Code:
PHONE NUMBERS
Home:
Work:
Cell:
E-Mail Address:
Best Time to Contact You:
Referred By:
Previously Employed
- Date:
General Inquiry
Job Fair
Classified Ad
- Publication:
Current Employee
- Name:
Other
-
Position applying for:
Full-Time
Part-Time
Seasonal
Internship
Are you willing to work weekends?
Yes
No
Are you willing to relocate?
Yes
No
Due to Child Labor Laws, employees must be 16 years of age to participate in certain job responsibilities.
Are you at least 18 years of age?
Yes
No
Are you at least 16 years of age?
Yes
No
Do you, or anyone you live with, have contact with swine?
Yes
No
If yes, please explain:
Do you, or anyone you live with, work with meat processing?
Yes
No
If yes, please explain:
Do you have reliable transportation?
Yes
No
Have you been convicted within the last five years of a felony?
Yes
No
If yes, please explain:
EDUCATION
High School:
College or University:
Other (Vocational or Trade School/On Line):
Grade Completed:
Grade Completed:
Grade Completed:
Did you graduate?
Yes
No
Did you graduate?
Yes
No
Did you graduate?
Yes
No
Major:
Major:
Major:
EMPLOYMENT HISTORY
Starting with your most recent employer, please detail your last 5 years of work history. Please explain breaks of employment between positions.
1.
Company Name:
City:
State:
ZIP Code:
Supervisor's Name:
Phone Number:
Can be contacted?
Yes
No
Start Date:
End Date:
Pay Start:
Pay End:
Job Description:
Reason for leaving:
2.
Company Name:
City:
State:
ZIP Code:
Supervisor's Name:
Phone Number:
Can be contacted?
Yes
No
Start Date:
End Date:
Pay Start:
Pay End:
Job Description:
Reason for leaving:
3.
Company Name:
City:
State:
ZIP Code:
Supervisor's Name:
Phone Number:
Can be contacted?
Yes
No
Start Date:
End Date:
Pay Start:
Pay End:
Job Description:
Reason for leaving:
4.
Company Name:
City:
State:
ZIP Code:
Supervisor's Name:
Phone Number:
Can be contacted?
Yes
No
Start Date:
End Date:
Pay Start:
Pay End:
Job Description:
Reason for leaving:
5.
Company Name:
City:
State:
ZIP Code:
Supervisor's Name:
Phone Number
Can be contacted?
Yes
No
Start Date:
End Date:
Pay Start:
Pay End:
Job Description:
Reason for leaving:
6.
Company Name:
City:
State:
ZIP Code:
Supervisor's Name:
Phone Number:
Can be contacted?
Yes
No
Start Date:
End Date:
Pay Start:
Pay End:
Job Description:
Reason for leaving:
7.
Company Name:
City:
State:
ZIP Code:
Supervisor's Name:
Phone Number:
Can be contacted?
Yes
No
Start Date:
End Date:
Pay Start:
Pay End:
Job Description:
Reason for leaving:
8.
Company Name:
City:
State:
ZIP Code:
Supervisor's Name:
Phone Number:
Can be contacted?
Yes
No
Start Date:
End Date:
Pay Start:
Pay End:
Job Description:
Reason for leaving:
AGRICULTURAL / MANAGERIAL / OFFICE EXPERIENCE
Please rate your experience/knowledge level from 1 through 5. (1 = no experience; 5 = very experienced)
Gestation
Moving Sows
1
2
3
4
5
Hand Feeding
1
2
3
4
5
Auto Feed
1
2
3
4
5
Hand Mating
1
2
3
4
5
Pen Mating
1
2
3
4
5
AI Mating
1
2
3
4
5
Semen Collection
1
2
3
4
5
Finishing
Sorting
1
2
3
4
5
Marketing
1
2
3
4
5
Treating Sick Pigs
1
2
3
4
5
Selecting Breed Stock
1
2
3
4
5
Marking Slaughter Hogs
1
2
3
4
5
Sprinklers
1
2
3
4
5
Transportation
CDL License
1
2
3
4
5
Tractor-Trailer Cert
1
2
3
4
5
Stick Shift
1
2
3
4
5
Air Brake Certified
1
2
3
4
5
Facility Types
Pasture
1
2
3
4
5
MOF
1
2
3
4
5
Renovated
1
2
3
4
5
Confinement
1
2
3
4
5
Farrowing
Assisting Farrowing
1
2
3
4
5
Injecting Pigs
1
2
3
4
5
Processing Pigs
1
2
3
4
5
Treating Sick Pigs
1
2
3
4
5
Cross Fostering Pigs
1
2
3
4
5
Split Weaning
1
2
3
4
5
Managing People
Supervising
1
2
3
4
5
Dealing w/ performance
1
2
3
4
5
Understanding benefits
1
2
3
4
5
Dealing w/ work comp
1
2
3
4
5
Dealing w/ unemployment
1
2
3
4
5
Giving constructive criticism
1
2
3
4
5
Taking constructive criticism
1
2
3
4
5
Teaching Tasks/Values
1
2
3
4
5
Scheduling work/duties
1
2
3
4
5
Scheduling employees
1
2
3
4
5
Solving problems
1
2
3
4
5
Conflict resolution
1
2
3
4
5
Leadership training
1
2
3
4
5
General Equipment
Cooling Systems
1
2
3
4
5
Gas Heaters
1
2
3
4
5
Pressure Washers
1
2
3
4
5
Feeders/Augers
1
2
3
4
5
Manure Systems
1
2
3
4
5
Nursery
Sorting to size
1
2
3
4
5
Managing sick pens
1
2
3
4
5
Treating sick pigs
1
2
3
4
5
Managing medicators
1
2
3
4
5
Giving vaccinations
1
2
3
4
5
Records
Individual sows
1
2
3
4
5
Breeding
1
2
3
4
5
Inventory
1
2
3
4
5
Feed
1
2
3
4
5
Computer
1
2
3
4
5
Analysis
1
2
3
4
5
Problem solving
1
2
3
4
5
Maintenance
Thermostats
1
2
3
4
5
Ventilation fans
1
2
3
4
5
Welding
1
2
3
4
5
Carpentry
1
2
3
4
5
Plumbing
1
2
3
4
5
Electrical
1
2
3
4
5
Computer Skills
Microsoft Access
1
2
3
4
5
Microsoft Excel
1
2
3
4
5
Microsoft Word
1
2
3
4
5
Data Entry
1
2
3
4
5
Please list your strengths:
Please list any areas needing growth/improvement:
Please list any additional information:
In order to perform the essential functions of a Swine Technician with EMP SERV, LLC 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.
Use power washer with 3000 psi force and 5 gallons per minute flow.
Frequently lift objects weighing 3 to 20 pounds.
Occasionally 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 assistance of another person as needed.
Yes
No
Do you understand the essential functions required for the position?
Yes
No
Can you perform the essential functions of this job?
Please list any relevant experience not listed in the Employment History section:
Why are you interested in this position?
BUSINESS REFERENCES
List 3 persons,
other than relatives
, who are familiar with your work history. Submitting this form indicates your consent for EMP SERV, LLC to contact these references.
1.
Name:
Address:
Telephone (w/ Area Code):
Occupation/Relationship:
Years Known:
2.
Name:
Address:
Telephone (w/ Area Code):
Occupation/Relationship:
Years Known:
3.
Name:
Address:
Telephone (w/ Area Code):
Occupation/Relationship:
Years Known:
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.
Note: All applicants should be advised that the Social Security Administration verifies the validity and authenticity of information given to EMP SERV, LLC’s Human Resource 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. Federal law provides for imprisonment and/or fines for employees who present false documents and/or give false information in connection with the completion of the I-9. EMP SERV, LLC will provide no reimbursement, support or sponsorship for any employee found to have presented false information regarding employment eligibility.
EMP SERV, LLC does not discriminate based on race, color, religion, sex, disability, marital status, place of national origin, and other categories protected by law, with regard to employment, promotion, compensation and working conditions.
Pre-employment drug test and background screening required.
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