Premium Iowa Pork Recruitment Application Form

Employment Application:

Premium Iowa Pork 108 1st Ave Hospers, IA Phone: 712.752.8666 Premium Minnesota Pork 1174 CO Hwy 4 Luverne, MN Phone: 507.449.7670
Personal Information:
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail
Are You Eligible to Work in the US?*

YesNo
SSN if applicable
Are you 18 Years or Older?*

YesNo
How did you hear about us?
If referred by a Premium Iowa Pork employee, what is the name of the employee?
Employment Desired:

The following information is required for a bone fide occupational qualification.
Have You Ever Worked in a Meat Packing Plant?*

YesNo
Have You Worked for Premium Iowa Pork LLC?*

YesNo
Which location?

Luverne, MNHospers, IA
Dates Worked
What Languages Do You Speak Fluently?
Location Applying For:*

Luverne, MNHospers, IAWindom, MNEither Location
Have you been convicted of a felony or misdemeanor within the last 5 years? You will not be denied employment solely because of a conviction record unless the offense is related to the job for which you have applied*

YesNo
If you answered yes to the above question, please describe:
Please mark your preferred position and shift (please select all that may apply):*

1st Shift: Ham Line1st Shift: Barn1st Shift: Kill Floor1st Shift: Cut Floor1st Shift: Shipping1st Shift: Packaging1st Shift: Maintenance1st Shift: Office1st Shift: Quality Assurance1st Shift: Supply2nd Shift: Ham Line2nd Shift: Shipping2nd Shift: Maintenance2nd Shift: Quality Assurance3rd Shift: Maintenance
WINDOM, MN ONLY - Please mark your preferred position and shift (please select all that may apply):

ManagementMaintenanceQuality AssuranceOfficeProduction
Date You Can Start*

MonthDayYear
Are you employed now?*

Yes, and you may inquire of my present employerYes, and please DO NOT inquire of my present employerNo
Education:

*The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age.
Grammar School
Name of High School Attended
Where was your grammar school located?
Name of Grammar School Attended
Number of Years Attended
High School
Name of High School Attended
Where was your high school located?
Name of High School Attended
Number of Years Attended
Graduated?

Yes
College
Name of College/University Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Trade School/Other
Name of Trade/Technical/Other School Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Skills/Qualifications:
Skills
List any relevant skills (knife experience, computer, licenses, certifications, etc)
Former Employers

Please list below the last three employers, starting with last one first
Name of Employer*
If none, please list NONE
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position
Phone Number

Area CodePhone Number
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
Date
Name of Employer
Name of Previous Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position
Phone Number

Area CodePhone Number
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
Name of Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position
Phone Number

Area CodePhone Number
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
References:

Give the names of three persons not related to you, whom you have known at least one year
Reference 1*
Name of Reference
Years Acquainted*
Phone Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Reference 2*
Name of Reference
Years Acquainted*
Phone Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Reference 3*
Name of Reference
Years Acquainted*
Phone Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Physical Record
Do you have any physical limitations that prevent you from performing any work for which you are being considered?*

YesNo
If yes, please describe
What can be done to accommodate your limitation?
Emergency Contact

In case of emergency notify:
Emergency Contact:*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Relationship*
Cover Letter & Resume (Optional):
Cover Letter

Upload a File

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Resume

Upload a File

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Send Application:
*I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND I UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL.

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE PERSONAL OR OTHERWISE, AND RELEASE ALL PARTIES FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING SAME TO YOU.

I UNDERSTAND AND AGREE THAT IF HIRED, MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT ANY PRIOR NOTICE. *
Signature

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Employment Application:

Personal Information:

Employment Desired:

Education:

Skills/Qualifications:

Former Employers

References:

Physical Record

Emergency Contact

Cover Letter & Resume (Optional):

Send Application: