Careers, Job Openings | Binghamton Agway

Employment Application

Please fill out this online application for employment with us. If you would like to send us a resume as well, please email to gary@sliters.com.
Position you are applying for:*
Days You are Available for Work*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Hours You Are Available for Work*

MorningsAfternoonsEveningsAnytime
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
Are you 18 years of age or older?*

YesNo
References
Please fill out this section with 3 personal or professional references.
Reference 1
Please give name and contact information. Also, specify their relationship to you.
Reference 2
Please give name and contact information. Also, specify their relationship to you.
Reference 3
Please give name and contact information. Also, specify their relationship to you.
Education
Please fill out the Education portion of this Form to the best of your ability.
High School Education
Please include school name and dates you have attended.
Please describe any education you may have beyond High School.
Please describe any courses, certificates or training you may have beyond High School.
Previous Employment
Please fill out this section starting with your last Employer to the best of your knowledge.
Professional/Work Experience
Describe work experience.
Are you currently employed?*

YesNo
May we contact your present employer?

YesNo
What is the date you are available to work?*

MonthDayYear
Date
What is your desired range of compensation?*
After Professional/Work Experience, Please explain any gaps in your employment.
Other Information
Do you have reliable transportation?*

YesNo
Are you willing to submit to drug testing?*

YesNo
Please describe your qualifications here.
Include special skills or qualifications, job-related training received in U.S. Military, list any professional, trade, business or civic actives or offices held.
What is your preferred Sliters location? *
Are you available for part-time, seasonal or full-time employment? *
Do any of your friends or relatives work at Sliters?*

YesNo
If Yes, list their name(s) and relationship to you.
Certification and Signature
I certify that the information on this application is true and correct to the best of my knowledge and I understand that any misrepresentation or omission of fact shall be cause for disqualification for employment or dismissal from employment. I hereby authorize an investigation of statements contained in the application and release from all liability and claims all persons and companies supplying information. I understand that my employment with the company would not be for any fixed period of time and that, if employed, I may resign at any time for any reason or the company my terminate my employment at any time for any reason.
Signature*

Clear
Date*

MonthDayYear
Date
Please verify that you are human*
Should be Empty:

Employment Application