Valley Dairy - Valley Car Wash
Grand Forks, ND and East Grand Forks, MN
Application For Employment
 
This information is only collected for the purpose of your job application, and will not be given out or sent to anyone other than the person who is reviewing your application.
Fields marked with a * are required
* Date:
Position Applied for:
Referred by:
 Advertisement
Walk-in
Friend
Other:
* First Name:
  
* Middle Name:
  
* Last Name:
  
Email Address:
  
Social Security Number:
  
* Phone No.:
  
  Address:  
* Street:
  
* City:
  
* State:
  
* Zip:
  
  Permanent Address  
* Street:
  
* City:
  
* State:
  
* Zip:
  
* Are you 18 yrs or older?
 Yes No  
* Are you legally eligible for employment in the United States?
 Yes No
* Have you ever been employed with Valley Dairy or Valley Car Wash?
 Yes No
 
If yes, where?
 
When?
How many hours per week would you like to work?
Date available to start?
What times of the day would you like to work? (check all that apply)

Days
Afternoon/Evenings (3-11pm)
Nights 11pm-7am
Other:

Hours Available:    
Sunday
Monday
Tuesday
From:
To:
Wednesday
Thursday
Friday
From:
To:
Saturday
From:
To:
* Have you ever been convicted of a crime other than a routine traffic violation?
No Yes
If yes, give date and circumstances:

(conviction does not automatically bar candidate)
 
  In case of emergency notify:
* Name:
* Address:
* Phone No:
EDUCATION NAME AND LOCATION OF SCHOOL NO. OF YEARS ATTENDED DID YOU GRADUATE? SUBJECTS STUDIED
ELEMENTARY SCHOOL Yes
No
HIGH SCHOOL Yes
No
COLLEGE Yes
No
TRADE, BUSINESS OR CORRESPONDENCE SCHOOL Yes
No

EMPLOYMENT HISTORY
1.  
Employer:
Job Title:
Start Date :
End Date:
Street, City, State, Zip:
Supervisor:
Wage/Salary Start:  / hour
Wage/Salary End:  / hour
Telephone Number(s):
Duties and Responsibilities:
Reason for leaving:
2.  
Employer:
Job Title:
Start Date :
End Date:
Street, City, State, Zip:
Supervisor:
Wage/Salary Start:  / hour
Wage/Salary End:  / hour
Telephone Number(s):
Duties and Responsibilities:
Reason for leaving:
3.  
Employer:
Job Title:
Start Date :
End Date:
Street, City, State, Zip:
Supervisor:
Wage/Salary Start:  / hour
Wage/Salary End:  / hour
Telephone Number(s):
Duties and Responsibilities:
Reason for leaving:


REFERENCES: Give the names of 2 people not related to you,
whom you have known at least 1 year.

1. * Name:
  Address:
  * Phone #:
  Business:
  Yrs Acquainted:

 

2. * Name:
  Address:
  * Phone #:
  Business:
  Yrs Acquainted:

I hereby certify that all of the facts and information listed on this employment application are true and complete. I understand that any false, incomplete or misleading information given by me on this application is sufficient cause for rejection of this application, or if discovered after I am employed, may result in my dismissal.

I authorize VALDAK Corporation to conduct, at its discretion, felony convictions and motor record searches. I also authorize investigation of all statements contained in this application, to interview the references and previous employers listed in this application, and to obtain a report from a consumer reporting agency to be used for employment purposed in accordance with Fair Credit Reporting Act. I authorize the references and previous employers listed to give the Company all facts, opinions and evaluations concerning my previous employment and any other information determined by VALDAK Corporation. I release all such parties from any liability which may allegedly arise from furnishing such information to the Company, including, but not limited to, any liability for defamation or invasion of privacy.

If I am offered employment, I understand that such an offer will be conditioned upon satisfactory results of a background investigation and/or Company medical examination or inquiry, including a drug screen test. I further understand that my employment and compensation can be terminated, with or without cause or notice, at any time, at the option of either the Company or myself. I understand that no manager, supervisor or other representative of the Company other than the President of the Company has any authority to enter into any agreement for employment for any specified period or time, or to make any agreement contrary to
the foregoing.

I further understand and voluntarily agree as a condition of employment or my continued employment, that I may be requested by the Company to submit to drug screen test and that my failure to take such a test(s) when requested to do so or unsatisfactory test results will disqualify me from consideration for employment, or if I am employed, may result in my dismissal.

I certify that I have read, understand and agree with the above.

* Your Initials:

* Date: