Application for Employment

Fields marked with asterisk (*) are mandatory.

Community Coops | PO Box 329 | Lake Park, MN 56554 | Ph. 218-238-5911

Community Coops | PO Box 329
Lake Park, MN 56554 | Ph. 218-238-5911

We are an equal opportunity employer, dedicated to a policy of non‐discrimination in employment on any basis including race, color, age, sex, religion, handicap or national origin.

PERSONAL INFORMATION

First Name*

MI*

Last Name*

Street Address*

City*

State*

Zip*

Email*

Phone*

Are you 18 years of age or older?*YesNo

EMPLOYMENT DESIRED

Position applying for*

Job related skills*

Are you currently employed?*YesNo

If yes, can we contact your employer?*YesNo

Date you can start?*

Salary Desired?*

EDUCATION

HIGH SCHOOL

Name / Location of School

Last year completed?

Did you graduate?

Subjects studied

COLLEGE

Name / Location of College

Last year completed?

Did you graduate?

Subjects studied

OTHER SCHOOL

Name / Location of School

Last year completed?

Did you graduate?

Subjects studied

EMPLOYMENT HISTORY
List below your last four employers, starting with the last one first:

EMPLOY 01

Date from*

To*

Name / Address of employer*

Phone #*

Supervisor*

Salary (upon leaving)*

Position*

Reason for leaving*

Please drop down the next 3 employs as you need, by clicking the “Drop” button at right hand:

EMPLOY 02

EMPLOY 02

Date from*

To*

Name / Address of employer*

Phone #*

Supervisor*

Salary (upon leaving)*

Position*

Reason for leaving*

EMPLOY 03

EMPLOY 03

Date from*

To*

Name / Address of employer*

Phone #*

Supervisor*

Salary (upon leaving)*

Position*

Reason for leaving*

EMPLOY 04

EMPLOY 04

Date from*

To*

Name / Address of employer*

Phone #*

Supervisor*

Salary (upon leaving)*

Position*

Reason for leaving*

REFERENCES
List below three persons not related to you, whom you have known at least one year.

REFERENCE 1

Name*

Phone*

Address*

Years acquainted*

REFERENCE 2

Name*

Phone*

Address*

Years acquainted*

REFERENCE 3

Name*

Phone*

Address*

Years acquainted*

If you are hired by the company, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identify and employment eligibility. You cannot be hired if you cannot comply with these requirements.

AUTHORIZATION

I certify the facts contained in this application and accompanying resume, are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the Company.

I understand that acceptance of this form does not indicate there is a position and does not obligate the Company to hire. If hired, I agree to abide by all Company work rules, policies and procedures. The Company retains the right to revise its policies or procedures, in whole or in part, at any time.

ACCEPTANCEYes I do

DATE*

Signature*