Upload a picture of yourself
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Name
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First Name
Middle Name
Last Name
Choose an option
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I have worked on a farm in the United States
I have NOT worked on a farm in the United States
Date of Birth
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-
Month
-
Day
Year
Date
Age
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Weight
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Please indicate kg or lbs
Height
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e.g. 5.6" or 1.67m
Select the option that best described your health
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Excellent
Good
Moderate
Poor
Please describe any health concerns (i.e. allergies/injuries that would affect any of your work duties)
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Marital Status
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Single
Engaged
Married
Divorced
Gender
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Male
Female
Are you a smoker?
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Yes
No
Do you have a pasport that is valid for at least the next 12 months?
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Yes
No
Do you have a valid South African Drivers License?
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Yes
No
Have you ever had a US Drivers license?
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Yes
No
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Write a short paragraph about yourself to the farmer.
*
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EXPERIENCE
Skills Information
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Livestock
Grain Cart
High boy (Spray Rig)
Harvesting/Combine
Crop
Mechanical
Trucking(18 Wheeler)
None
Other
Select crops you have experience with.
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Corn
Soybeans
Rice
Wheat
Cotton
Peanuts
Milo
Sunflowers
None
Other
Describe in detail what experience you have with the selected crops. For example, planting, harvesting, irrigation ect.
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If no experience type "N/A"
Select Livestock you have experience with.
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Cattle
Dairy Cattle
Sheep
Horses
Poultry
Pigs
None
Other
Describe in detail what experience you have with the selected livestock.
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If no experience type "N/A"
Select 18 Wheelers you have experience with.
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Manual
Automatic
Split Shift
None
Other
What Brand of tractors do you have experience with (i.e. what tractors can you operate)
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John Deere
Case
New Holland
Fendt
None
Other
Please list the models of the tractors you have experience with
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Select all of the equipment you have experience with.
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GPS Autosteer
Track driven Tractor
Articulating Tractor
Combine
Cotton Picker
Grain Cart
Field Cultivator
Air-drill Planter
Single Row Planter
Twin Row Planter
Chisel Plow
Disc
Harrow
Land Roller
Moldboard Plow
Mower
Round Baler
None
Other
Please describe in DETAIL the work you have done with above selected. (This includes what you can and cannot do on your own)
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If no experience type "N/A"
GPS/Satelite system(s) used? (This includes system name and how much you are able to work it on your own)
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e.g. Greenstar, Trimble etc.
Describe in DETAIL any other farming experience that you have.
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If no experience type "N/A"
Describe in DETAIL any other work experience that you have.
List all other skills you may have.
e.g. Welding (please specify)
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REFRENCES
I agree that any and all references provided on this form may be contacted by my Agent and/or future (potential) employer. (PLEASE NOTE THAT THESE REFERENCES SHOULD BE RELATED TO YOUR FARMING EXPERIENCE)
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Yes
No
Please input a previous or current employer. This includes, employer name, time at company, job description.
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Number for above reference.
*
Email for above reference. (If you have it)
example@example.com
Please input a previous. This includes, employer name, time at company, job description.
Number for above reference.
Email for above reference. (If you have it)
example@example.com
Please input a previous. This includes, employer name, time at company, job description.
Number for above reference.
Email for above reference. (If you have it)
example@example.com
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I agree that all the above information is true and accurate to the best of my knowledge.
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Yes
No
I agree that my contract/employment can be terminated should any of the information provided above be untrue.
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Yes
No
Submit
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