Winnebago Boone Farm Bureau Job Application

Job Application

PLEASE complete this application. All information pertinent to your background should be included. Thank you.
Current open positions include:
- Youth Development & Consumer Engagement Director (Job Description)- Full-time
- Ag Educator (Job Description)- Part-time
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Have you been at your present address for less than one year?
Please list previous address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Alternate Number
Format: (000) 000-0000.
Email
example@example.com
Are you at least age 18?

Position for which you are applying for?
How did you learn about this opening?
Date available for work:

MonthDayYear
Date
Salary Expected:
Would you be available to work nontraditional hours, such as nights and/or weekends?
If you would be able to work part-time or nontraditional hours, please detail your availability.
In order to help us verify your credentials, please list any other names by which you have been known.
List any acquaintances or relatives associated with this organization:
Have you previously worked us?
If so, when?

Employment History
Dates Employed (from___ to___)
Company Name:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Supervisor's Name & Title
Your position & duties:
Reason for leaving:

Employment History

Continued
Dates Employed (from___ to___)
Company Name:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Supervisor's Name & Title
Your position & duties:
Reason for leaving:

Employment History

Continued
Dates Employed (from___ to___)
Company Name:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Supervisor's Name & Title
Your position & duties:
Reason for leaving:

Employment History

Continued
Dates Employed (from___ to___)
Company Name:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Supervisor's Name & Title
Your position & duties:
Reason for leaving:
Upload Your Resume

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Have you ever been fired, dismissed, asked to resign, resigned by mutual agreement, or otherwise been terminated from any job?
If, "Yes," what job and why?
May your present employer be contacted for a reference?
Why do you wish to change your present employment?
Which of your former jobs did you like best?
Why?

Professional References

Exclude relatives.
Name

First NameLast Name
Occupation
Relationship:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (Work)
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number (Home/Cell)
Please enter a valid phone number.Format: (000) 000-0000.

Professional References Continued

Exclude relatives.
Name

First NameLast Name
Occupation
Relationship:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (Work)
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number (Home/Cell)
Please enter a valid phone number.Format: (000) 000-0000.

Professional References Continued

Exclude relatives.
Name

First NameLast Name
Occupation
Relationship:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (Work)
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number (Home/Cell)
Please enter a valid phone number.Format: (000) 000-0000.

VISA INFORMATION

The federal immigration law requires every employee to certify his or her identity and eligibility for U.S. employment.
Are you legally authorized to work in the United States?
Will you now or in the future require sponsorship for employment visa status (e.g. H-1B visa status)
I understand and agree that any employment entered into between this company and me is conditioned upon the truthfulness of the statements contained in this application. I give you the right to investigate all statements given in this application. If hired, I agree to furnish proof of my eligibility to work in the United States (as specified in the Immigration Reform and Control Act of 1986) within seventy-two (72) hours of my starting date.

I agree that any lawsuit or claim against this company arising out of my employment or termination of employment must be brought within the following time limiits: within (i) 180 days of the event(s) giving rise to the claim or (ii) the time limit specified by statue, whichever is shorter. I waive any statute of limitations that exceeds this time limit.

I hearby acknowledge that I have read this employment application in its entirety, and I further understand that this application is not a contract of employment, and that any individual who is hired may voluntarily leave employment or be terminated by the employer at any time. I understand that any oral or written statement to the contrary is hearby expressly disavowed, and should not be relied upon by any prospective or existing employee.
Signature
Date

MonthDayYear
Date
Should be Empty:

Job Application

Education

Employment History

Employment History

Employment History

Employment History

Professional References

Professional References Continued

Professional References Continued

VISA INFORMATION