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 Name Middle Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

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

Yes No
SSN if applicable
Are you 18 Years or Older? *

Yes No
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? *

Yes No
Have You Worked for Premium Iowa Pork LLC? *

Yes No
Which location?

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

Luverne, MN Hospers, IA Either 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 *

Yes No
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 Line 1st Shift: Barn 1st Shift: Kill Floor 1st Shift: Cut Floor 1st Shift: Shipping 1st Shift: Packaging 1st Shift: Maintenance 1st Shift: Office 1st Shift: Quality Assurance 2nd Shift: Ham Line 2nd Shift: Shipping 2nd Shift: Maintenance 2nd Shift: Quality Assurance 3rd Shift: Maintenance
Date You Can Start *

Month Day Year
Are you employed now? *

Yes, and you may inquire of my present employer Yes, and please DO NOT inquire of my present employer No
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

City State / Province

Postal / Zip Code
Position
Phone Number

Area Code Phone Number
Salary
Reason for Leaving?
Start Date

Month Day Year
End Date

Month Day Year
Date
Name of Employer
Name of Previous Employer
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Position
Phone Number

Area Code Phone Number
Salary
Reason for Leaving?
Start Date

Month Day Year
End Date

Month Day Year
Name of Employer
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Position
Phone Number

Area Code Phone Number
Salary
Reason for Leaving?
Start Date

Month Day Year
End Date

Month Day Year
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 Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

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

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

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

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

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

Yes No
If yes, please describe
What can be done to accommodate your limitation?
Emergency Contact

In case of emergency notify:
Emergency Contact: *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

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