POSITION APPLIED FOR  _________________________   DATE  _________

 

 

Please Print in Ink

PERSONAL INFORMATION

 

Name ________________________________________________________________________________           

                   (Last)                                                                    (First)                                                                      (Middle Initial)

 

Address ______________________________________________________________________________

 

Previous Address _______________________________________________________________________

 

Telephone No ______________________________      Business No ______________________________ 

 

Soc. Sec. No. _____   ____   _____ Are you legally eligible to work in the United States? ___ Yes  ___ No

 

(The Immigration Reform and Control Act of 1986 requires that all applicants

provide evidence of identity and eligibility to work prior to employment)

 

 

 

AVAILABILITY

 

Available Start Date  _________________________      Salary Range  ____________________________ 

 

Category Preferred         _____ Full Time             _____ Part Time            _____ Temporary                     

 

Available Schedule  ___ Weekdays   ___ Weekends   ____Evenings   ___Nights   ___Overtime   ___Shift

 

 

 

SECURITY

 

List states and countries of residence for the past seven years  __________________________________

 

Have you used any names or S.S. numbers other than those on this page?  ___ Yes  ___ No

(If so, please list them under “Additional Information” section)

 

Have you been convicted of a felony?  ___ Yes  ___ No

(A conviction record will not necessarily be a bar to employment; various factors will be taken into consideration.)

 

If so, please explain ____________________________________________________________________

 

 

 

 

EDUCATION/TRAINING

 

High School___________________________________________________________________________           

                                                                                        City/State                        Graduate?                               Degree?  

 

College/Univ__________________________________________________________________________            

                                                                                        City/State                        Graduate?                               Degree?                                                                 

Graduate_____________________________________________________________________________            

                                                                                        City/State                        Graduate?                               Degree?  

 

Other________________________________________________________________________________           

                                                                                        City/State                        Graduate?                               Degree?  

 

Academic Average (2.58/4.0)      High School _____          College ______              Graduate School _____

 

Main area of courses taken ______________________________________________________________

 

Positions of leadership held ______________________________________________________________ 

 

Honors, awards received, including scholarships ______________________________________________

 

Professional and Community memberships and offices held (omit those which indicate race, religion, or national origin) _____________________________________________________________________________________

 

 

 

JOB RELATED SKILLS

(Do not fill out any part of this section you believe to be non-job related.)

 

If the job requires, do you have the appropriate valid drivers license? ___ Yes  ___ No

 

DL# _____________________________ Type _________________________ State of Issue __________

 

Have you had any moving violations? Please describe  _________________________________________

 

Have you been given a job description? ___ Yes  ___ No

 

Do you understand the requirements for this job? ___ Yes  ___ No

 

What types of office equipment can you operate? _____________________________________________

 

Are you fluent in any other languages? ___ Yes  ___ No

 

If so, please explain ____________________________________________________________________

 

 

 

 

 

 

 

 

 

 

EMPLOYMENT REFERENCES

(Your application will not be considered unless every question in this section is answered.)

 

 

Most Recent Employer

 

­­­­­­­_______________________________      __________________     _______________________________

Company Name                                      City                               State     Phone Number

 

­­­­­­­­­­­­­­_______________________________      __________________________________________________

Dates Employed      From     Thru            Job Title                        Supervisor Name

 

_____________________________________________________________________________________Duties

___________________________________________________________________________________

Salary per (week, hour, yr)                     Reason for Leaving

 

 

Second Most Recent Employer

 

­­­­­­­_______________________________      __________________     _______________________________

Company Name                                      City                               State     Phone Number

 

­­­­­­­­­­­­­­_______________________________      __________________________________________________

Dates Employed      From     Thru            Job Title                        Supervisor Name

 

_____________________________________________________________________________________Duties

 

___________________________________________________________________________________

Salary per (week, hour, yr)                     Reason for Leaving

 

 

 

Third Most Recent Employer

 

­­­­­­­_______________________________      __________________     _______________________________

Company Name                                      City                               State     Phone Number

 

­­­­­­­­­­­­­­_______________________________      __________________________________________________

Dates Employed      From     Thru            Job Title                        Supervisor Name

 

_____________________________________________________________________________________Duties

 

___________________________________________________________________________________

Salary per (week, hour, yr)                     Reason for Leaving

 

 

 

 

 

REFERENCES

(Include only individuals familiar with your work ability. Do not include relatives.)

 

 

­­­­­­­­­­­­­­_____________________________         _______________________________  ___________________

Name                                                    Address/Phone                                       Yrs. Known/Relationship

 

_____________________________         _______________________________    ___________________

Name                                                    Address/Phone                                       Yrs. Known/Relationship

 

 

 

ADDITIONAL INFORMATION

 

_____________________________________________________________

 

 

_____________________________________________________________

 

 

_____________________________________________________________

 

 

_____________________________________________________________

 

 

 

 

In order to comply with various legal requirements, it is necessary for the following statements to appear on this application.  Please read these statements carefully before affixing your signature.

 

I declare and affirm under penalty perjury that I am eligible to be employed in the United States.

 

If employed by East Fork Biodiesel, LLC, I understand and agree that the employment relationship will not be for any specific time period and may be terminated at the will of either myself or the Company.

 

I understand that as a condition of employment, I may be required to submit to a pre-employment drug/alcohol test per Part 382 of the Omnibus Transportation Employee Testing Act of 1991.  This Act requires employers to test all CDL licensed drivers for the illegal use of alcohol and controlled substances.

 

I authorize East Fork Biodiesel, LLC to investigate all statements in this application and to contact all employers and references.  I understand that false or misleading statements in this application will be sufficient cause for termination of consideration or for dismissal if already employed.

 

_____________________________________________________________ ___________________

Signature                                                                                                          Date

 

 

 

 

Voluntary Applicant Survey

 

East Fork Biodiesel, LLC is committed to the principles of Equal Employment opportunity. In order to monitor our EEO efforts and to comply with government record keeping, reporting and other legal requirements, we need to collect information from our job applicants. Completion of this self-identification form is voluntary. You will not be subjected to any adverse treatment if you do or do not provide the information requested. We would, however, appreciate your response. The form will be removed from your application materials upon receipt and will be kept confidential.

 

 

 

Name: _______________________________________________________________________________

            Last                                                                         First                                                                         Middle Initial

 

 

Position For Which You Are Applying: _______________________________________________________

 

Referral Source:

_____EFB Employee                                                             _____ Journal/Newspaper Ad: ________________________

 

_____ Friend/Relative                                                             _____ Job Posting Located At: ________________________

 

_____ Walk-in                                                                         _____ Other: ______________________________________

 

 

 

1. Sex:  _____ Male        _____ Female

 

2. Race:

 

            _____ AMERICAN INDIAN/ALASKAN NATIVE: Origins in North America, to include Alaska

            _____ ASIAN: Origins in Far East, Southeast Asia, or India (i.e., Cambodia, China, Japan, India, Korea, etc.)

            _____ NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER: Origins in Hawaii, Guam, Samoa, or other Pacific

                          Islands.

               _____ BLACK OR AFRICAN AMERICAN: Origins in Africa

            _____ HISPANIC OR LATINO: Persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish

                          culture or origin, regardless of race.

            _____  WHITE: Origins in Europe, North Africa, or the Middle East

_____  TWO OR MORE RACES: A combination of any of the above.