ProTrition Feed, LLC Employment Application

PROTRITON FEED, LLC EMPLOYMENT APPLICATION

If you need help filling out this application form or for any phase of the employment process, please notify the person that gave you this form and every effort will be made to accommodate your needs in a reasonable amount of time. Print clearly; incomplete or illegible applications will not be processed. Please note "Not applicable" if not answering a question.

TODAY'S DATE*

Date

FIRST NAME*

MIDDLE INITIAL

LAST NAME*

HOME PHONE

Please enter a valid phone number.

CELL PHONE*

Please enter a valid phone number.

WORK PHONE

Please enter a valid phone number.

E-MAIL ADDRESS*

example@example.com

CURRENT ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

PRIOR ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

APPLICANT NOTE: This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, color, age, creed, national origin, sexual orientations, military reserve membership, ancestry, religion, height, weight, use of a guide or support animal because of blindness, deafness or physical handicap, or the presence of disabilities. A felony conviction will not necessarily bar an applicant from employment. Additional testing of job-related skills and for the presence of drugs in your body may be required prior to employment. After an offer of employment, and prior to reporting to work, you may be required to submit to a medical review. Should an applicant be offered employment, his/her application shall become part of his/her employment record.

For which position are you applying?*

What date can you start?*

Enter Date

What category would you prefer?*

Full-timePart-time/Temporary

Can you work overtime?*

YesNo

For which schedules are you available? Please check all that apply:*

WeekdaysWeekendsEveningsNights

If the job requires, do you have the appropriate driver's license?

YesNo

Name on license, DL#, Type and State of issue

Please list any other skills, licenses or certificates you have that may be job-related or that you feel would be of value to this job or company.

Have you had any moving violations within the past 7 years?*

Yes - If so, please list below.No

Please describe moving violations if applicable:

SECURITY: List states and counties of residence for the past seven years.*

Have you used any names, other than given above?*

Yes - If so, please list below.No

If other names have been used, please list them here:

Have you been convicted of a crime in the past seven years?*

YesNo

If so, please describe below. (Conviction will not necessarily be a bar to employment.) In accordance with company policy and applicable state and federal laws, factors such as age at time of the offense, remoteness of the offense, time since last conviction, nature of the job sought and rehabilitation effort will be reviewed

PLEASE LIST CASE NUMBER/ COURT, CITY, COUNTY, STATE, OFFENSE OF WHICH YOU WERE CONVICTED

Are you currently working for this employer?*

YesNo

If yes, may we contact your current employer?

YesNo

COMPANY NAME*

CITY*

STATE*

PHONE*

Please list a valid phone number.

FAX

DATE EMPLOYED FROM*

Date

DATE EMPLOYED TO*

If present, please select date of application:

SUPERVISORS NAME*

SALARY (HOUR, WEEK, MONTH)*

JOB TITLE*

DUTIES*

REASON FOR LEAVING*

COMPANY NAME

CITY

STATE

PHONE

FAX

DATE EMPLOYED FROM

If present, please select date of application:

DATE EMPLOYED TO

Date

SUPERVISOR NAME

SALARY (HOUR, WEEK, MONTH)

JOB TITLE

DUTIES

REASON FOR LEAVING

COMPANY NAME

CITY

STATE

PHONE

FAX

DATE EMPLOYED FROM

If present, please select date of application:

DATE EMPLOYED TO

Date

SUPERVISOR NAME

SALARY (HOUR, WEEK, MONTH)

JOB TITLE

DUTIES

REASON FOR LEAVING

INCLUDE ONLY INDIVIDUALS FAMILIAR WITH YOUR WORK ABILITY. DO NOT INCLUDE RELATIVES.*

	Name	Address/Phone Number	Years Known/Relationship
REFERENCE 1
REFERENCE 2

High School

City/ State

Graduate?

YesNo

Degree Type and Year Graduated

College

City/ State

Graduate?

YesNo

Degree Type and Year Graduated

Other Education

City/ State

Graduate?

YesNo

Degree Type and Year Graduated

READ CAREFULLY-CERTIFICATION, RELEASE AND WAIVER

I certify that I have read and understand the Applicant Note on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejections of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information. I authorize all former employers, persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment. I agree that any claim or lawsuit relating to my service with ProTrition Feed, LLC or any of its parents or sister JV's must be filed no more than six (6) months after the date of the employment action that is the subject of the claim or lawsuit. I waive any statute of limitations to the contrary.

SIGNATURE*

DATE OF APPLYING*

ENTER TODAY'S DATE

PROTRITON FEED, LLC EMPLOYMENT APPLICATION

MOST RECENT EMPLOYER

SECOND MOST RECENT EMPLOYER

THIRD MOST RECENT EMPLOYER

REFERENCES

EDUCATION