AgriServe Risk Management Employment Application

Required Fields are RED

Applicant Information
Date:
  11/19/2008
Last Name:
First Name:
Middle Name:
Address:
City:
State:
Zip:
Phone:
(Example: 217-123-4567)
Position(s) Applied For:
E-mail Address:
Date Available:
(Example: 01/20/2004)
  Desired Salary:
(Example: 15.00 or 20,000)
  Do you have a legal right to be employed in the
United States ?  (If yes, proof is required)		 Yes No
  Have you ever worked for this company? Yes No
       If so, when? (Example: 06/2001)  
  Have you ever been convicted of a felony?
 Yes No
       If yes, please explain:  
(Maximum characters: 255)
You have characters left.
Education
High School
Enter Four Digit Years in From and To Fields (Example: 2001)
Name:
Address:
Number of Years Attended:
Did you graduate?
 Yes No      
Degree:
College
Name:
Address:
Number of Years Attended:
 Did you graduate?
Yes No
 
Degree:

Other School
Name:
Address:
Number of Years Attended:
 Did you graduate?
Yes No  
  
Degree:
References (Please list three professional references.)

Reference 1
  Full Name:   Relationship:
  Company:  Phone: (Example: 217-123-4567)
  Address:   

Reference 2
  Full Name:   Relationship:
  Company:   Phone: (Example: 217-123-4567)
  Address:   

Reference 3
  Full Name: Relationship:
  Company: Phone: (Example: 217-123-4567)
  Address:   
   
Previous Employment
  Job Title: From: (Ex: 06/2000)
To: (Ex: 06/2005)
   
  Supervisor: Starting Salary: Ending Salary:  
   
  Company Name:
 Address:

 Phone:
  Responsibilities:
  Reason for Leaving:
  May we contact your previous supervisor for a reference? Yes No   

  Job Title:
 From:
To:
 		 
  Supervisor: Starting Salary: Ending Salary:  
   
  Company Name:
 		Address:
 Phone:
  Responsibilities:
  Reason for Leaving:
  May we contact your previous supervisor for a reference? Yes No   

  Job Title:
 From:
 		To:
 
  Supervisor: Starting Salary: Ending Salary:  
   
  Company Name:
 		Address:
 Phone:
  Responsibilities:
  Reason for Leaving:
  May we contact your previous supervisor for a reference? Yes No   
Military Service
Military Service:
Yes No
If yes,
Number of Years of Service:
    
Branch of service:
Highest rank obtained:
Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. By signing below, I hereby authorize ASI to conduct background and/or criminal checks necessary for employment. 

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
  My typed name below shall have the same force and effect as my written signature.

  Signature: Date: 11/19/2008


Inside AgriServe

Important Dates

  •    09/30/2008 -
       Fall Crops
       Sales Closing Date
  •    10/01/2008 -
       Spring Crops
       Premium Due Date
  •    11/1/2008 -
       Cotton Premium
       Due Date
  •    11/15/2008 -
       Fall Acreage
       Reporting Due Date
       (varies by state)
  •    11/20/2008 -
       Perennial Crops
       Sales Closing Date
  •    11/30/2008 -
       Fall Acreage
       Reporting Due Date
       (varies by state)
  •    11/30/2008 -
       Sales Closing
       for GRP Forage,
       Pasture, Rangeland
  •    12/15/2008 -
       Fall Acreage
       Reporting Due Date
       (varies by state)