Careers, Job Openings | Binghamton Agway

The Stock Shop Employment Application

Join our team! Please submit your application below or stop in-store.
Personal Information
Today's Date*

MonthDayYear
Date
Name*

First NameMiddle NameLast Name
Present Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How Long Have You Lived At Your Present Address?*
Phone Number*

Area CodePhone Number
Email*
example@example.com
Are you 18 years of age or older?*

YesNo
Are you currently employed?*

YesNo
May we contact your present employer?*

YesNo
Have you ever been convicted of a felony?*

YesNo
If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s)imposed, and type(s) of rehabilitation.
Have you ever been employed with this company?*

YesNo
If yes, when?
If hired, would you have a reliable means of transportation to and from work?*

YesNo
Employment Desired
Position Applying For?*
Days You Are Available for Work*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Hours You Are Available for Work*

MorningsAfternoonsEvenings
How Many Hours Are You Available To Work A Week?*
Employment Desired*

Full-TimePart-TimeFull OR Part-Time
Date Available to Start *

MonthDayYear
Date
Education
High School Name
High School Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Years Completed
High School Diploma?

YesNo
College Name
College Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Years Completed
Major & Degree
Business Or Trade School Name
Business Or Trade School Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Years Completed
Major & Degree
Professional Or Graduate School Name
Professional Or Graduate School Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Years Completed
Major & Degree
Please Describe Other Training, Seminars, Coursework, etc. That Applies To The Job.
Work Experience

Please list your work experience for the past five years beginning with your mostrecent job held. If you were self-employed, give firm name. Attach additional sheets if necessary.
Name of Employer*
Address of Employer*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Name Of Supervisor*
Employment Dates - Employer 1*
From xx/xx/xxxx - xx/xx/xxxx
Your Last Job Title*
Reason For Leaving*
List The Jobs You Held, Duties Performed, Skills Used Or Learned, Advancements OrPromotions While You Worked At This Company.*
Name of Employer
Address of Employer

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Name Of Supervisor
Employment Dates - Employer 1
From xx/xx/xxxx - xx/xx/xxxx
Your Last Job Title
Reason For Leaving
List The Jobs You Held, Duties Performed, Skills Used Or Learned, Advancements OrPromotions While You Worked At This Company.
Name of Employer
Address of Employer

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Name Of Supervisor
Employment Dates - Employer 1
From xx/xx/xxxx - xx/xx/xxxx
Your Last Job Title
Reason For Leaving
List The Jobs You Held, Duties Performed, Skills Used Or Learned, Advancements OrPromotions While You Worked At This Company.
References

Please list below three persons not related to you who have knowledge of your work performance and/or personal qualifications within the last 5 years.
Reference Name*

First NameLast Name
Occupation
Company Name
Reference Phone Number*

Area CodePhone Number
Reference Email Address*
example@example.com
Years Acquainted*
Reference Name*

First NameLast Name
Occupation
Company Name
Reference Phone Number*

Area CodePhone Number
Reference Email Address*
example@example.com
Years Acquainted*
Reference Name*

First NameLast Name
Occupation
Company Name
Reference Phone Number*

Area CodePhone Number
Reference Email Address*
example@example.com
Years Acquainted*
Additional Information

An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.
Additional Comments:
File Upload

Cancelof
Signature*

Clear
Today's Date*

MonthDayYear
Date
This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.

Thank you for completing this application form and for your interest in our business.
Please verify that you are human*
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The Stock Shop Employment Application

Personal Information

Employment Desired

Education

Work Experience

References

Additional Information