Application for Distribution (Farm/Loading)


Basic Information


First Name*


Last Name*


Middle Name*


Present Address*








Phone Number*


Permanent Phone Number*


Email Address*


19 years or older?*




Are you currently a student?*




Major/Area of Study?


Expected Graduation Date?


Are you a college graduate?*




Are you a high school graduate?*




Driving Information


Do you have a valid driver's license?*


Driver’s License (State)


License Number


Expiration Date


Have you been convicted of a DUI within the last five years?*


Background Information


Have you been convicted of a felony within the last 7 years?*


If yes, explain below (conviction will not necessarily disqualify applicant from employment)


Special Skills


Do you have any special skills which you would like to tell us about?


Physical Limitations


Are you able to work on your feet for 8-10 hour days?


Are you able to bend and stoop repeatedly for 8-10 hours?


Are you able to lift 30lbs repeatedly?


Are you able to lift 50lbs?


Are you able to grasp with your fingers for 8-10 hours?


Are you able to work outdoors, which could iclude weather as cold and 25 degrees as hot as 95 degrees, and long term sun exposure?


If no to any question, what can be done to accommodate your limitation?


Employment History


Name & Location of Employer










Your positions / responsibilities


Reason for Leaving

Add another

Personal References






Phone Number

Add another



How many hours per week would you like to work?
















*if hired, your schedule may or may not use all your available hours.


Additional information about your schedule or events coming up?


Other Questions


How did you learn about our job opening?


How does a temporary seasonal position fit into your plans?


Release and Confirmation


This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be grounds for immediate dismissal.

I authorize investigation of all statements contained herein and the referrals listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

I understand and agree that, if hired, any employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any prior notice.

I understand that entering my full legal name in the box below is the electronic equivalent of a signature.


Enter your full legal name in the box below if you agree to the Release and Confirmation.*


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