Careers, Job Openings | Binghamton Agway

Name*

First NameMiddle InitialLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Email*

example@example.com

Date Available to Start

Date

Desired Salary

Position Applying for*

Location Applying to*

Type of Employment Desired?*

Full TimePart Time

If you chose Part Time above, please specify hours:

Are you 18 years of age or older?*

YesNo

Are you authorized to work in the U.S.?*

YesNo

Have you ever worked for this company?*

YesNo

If so, when?

Have you ever been convicted of a felony?*

YesNo

If yes, explain

All applicants: Do not include convictions that were sealed, annulled by a court, or expunged, or convictions that resulted in referral to a diversion program.

Have you ever plead guilty or no contest to, or been convicted of any criminal offense other than traffic related offenses?*

YesNo

CRIMINAL OFFENSES ONLY: If you answered Yes to above question, provide the dates(s) and explain in accordance with the above instructions so that individual circumstances can be considered.

Criminal convictions or arrests will not automatically disqualify an applicant from a particular job. The Company will consider the nature of the crime, its seriousness, the substantial relation to the position’s functions and qualifications, the number of occurrences, the time elapsed since the crime, the applicant’s entire work and educational history, employment references and recommendations, and the business necessity of any exclusion when required by law.

High School Name

Did you graduate?

YesNo

College Name

Did you graduate?

YesNo

Degree

Other

Did you graduate?

YesNo

Degree

Reference 1

First NameLast Name

Title

Company

Phone Number

Reference 2

First NameLast Name

Title

Company

Phone Number

Reference 3

First NameLast Name

Title

Company

Phone Number

Name of Company - Employer 1

Phone Number - Employer 1

Address - Employer 1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Supervisor - Employer 1

Job Title - Employer 1

Starting Salary - Employer 1

$

Ending Salary - Employer 1

$

Responsibilities - Employer 1

Employment Dates - Employer 1

From - To

Reason for leaving

May we contact your previous supervisor for a reference?

YesNo

Name of Company - Employer 2

Phone Number - Employer 2

Address - Employer 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Supervisor - Employer 2

Job Title - Employer 2

Starting Salary - Employer 2

$

Ending Salary - Employer 2

$

Responsibilities - Employer 2

Employment Dates - Employer 2

From - To

Reason for leaving

May we contact your previous supervisor for a reference?

YesNo

Name of Company - Employer 3

Phone Number - Employer 3

Address - Employer 3

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Supervisor - Employer 3

Job Title - Employer 3

Starting Salary - Employer 3

$

Ending Salary - Employer 3

$

Responsibilities - Employer 3

Employment Dates - Employer 3

From - To

Reason for leaving

May we contact your previous supervisor for a reference?

YesNo

Have you ever been terminated or asked to resign from any job?

YesNo

Has your employment ever been terminated by mutual agreement?

YesNo

Have you ever been given the choice to resign rather than be terminated?

YesNo

Certification and Signature
I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my immediate termination of employment.

I understand and agree that if driving is a requirement of the job for which I am applying, my employment and/or continued employment is contingent on possessing a valid driver’s license for the state in which I reside and automobile liability insurance in an equal to the minimum required by the state where I reside.

I understand that the Company may now have, or may establish a drug-free workplace or drug and/or alcohol testing program consistent with applicable federal, state, and local law. If the Company has such a program and I am offered employment, I understand that if a pre-employment drug and/or alcohol test is positive, the employment offer may be withdrawn. I agree to work under the conditions requiring a drug-free workplace, consistent with applicable federal, state, and local law. I understand that the taking of alcohol and/or drug tests is a condition of continual employment and I agree to undergo alcohol and drug testing consistent with the Company’s policies and applicable federal, state, and local law.

If employed by the Company, I understand and agree that the Company, to the extent permitted by federal, state, and local law, may exercise its right, without prior warning or notice, to conduct investigations of property (including, but not limited to, files, lockers, desks, vehicles, and computers) and, in certain circumstance, my personal property.

I understand and agree that as condition of employment and to the extent permitted by federal, state, and local law, I may be required to sign confidentiality, restrictive covenant, and/or conflict of interest statement, as well as an agreement to arbitrate.

I authorize the Company or its agents to confirm all statement contained in this application and/or resume as if relates to the position I am seeking and to the extent permitted by federal, state, or local law. I agree to complete any requisite authorization forms for the background investigation.

I authorize and consent to, without reservation, any party or agency contacted by this employer to furnish the above-mentioned information. I hereby release, discharge, and hold harmless, to the extent permitted by federal, state, and local law, any party delivering information to the Company and its representative for seeking such information and all other persons, corporations, or organizations furnishing such information.

If hired by this Company, I understand that I will be required to provide genuine documentation establishing my identity and eligibility to be legally employed in the Unites States by this Company. I also understand this Company employs only individuals who are legally eligible to work in the Unites States.

This company is an at-will employer as allowed by applicable state law. This means that regardless of any provision in this application, if hired, the company or I may terminate the employment relationship at any time, for any reason, with or without cause or notice. Nothing in this application or in any document or statement, written or oral, shall limit the right to terminate employment at-will. No officer, employee or representative of the company is authorized to enter into an agreement—express or implied—with me or any applicant for employment for a specified period of time unless such an agreement is in a written contract signed by the president of the company.

This company is an Equal Opportunity Employer. The Company provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, genetics and any other protected class in accordance with Federal, State or Local law. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training

This application will be considered active for a maximum of sixty (60) days. If you wish to be considered for employment after that time, you must reapply.

Name (E-Signature)*

Date*

Date

Application for Employment Form

Education

References

Previous Employment