Employment Application - Gold-Eagle Cooperative

Candidates for Gold-Eagle Cooperative/Corn, LP Must, at a Minimum, Demonstrate the Following Characteristics:
*Submit to and pass a pre-employment drug screen & physical.
*Be fully bondable in accordance with applicable standards of our bonding company.

What is your contact info?

Name*

First Last

Address*

Street Address City State ZIP Code

Home Phone

Cell Phone*

Email*

Drivers License Number

Position Applying For:*

Position Type:

Full Time
Part Time
Seasonal / Internship

Available to Work:*

Days
Evenings
Weekends

Have you ever applied for employment with us?*

Yes
No

Apart from absence for religious observance, are you available for full-time work?

Yes
No

Will you work overtime if asked?

Yes
No

Are you legally eligible for employment in the United States?*

Yes
No

EDUCATION

School #1

Name of School*

Address*

City State / Province / Region

Grade Completed*

Did you graduate?*

Yes
No

Major*

School #2

Name of School

Address

City State / Province / Region

Grade Completed

Did you graduate?

Yes
No

Major

School #3

Name of School

Address

City State / Province / Region

Grade Completed

Did you graduate?

Yes
No

Major

SPECIAL TRAINING OR SKILLS

(Languages, Machine Operation, Etc.)

Please list any special training or skills that you feel would help with this job. Please list your Years of Experience and Degree of Proficiency.

Have you ever been convicted of or pled guilty to a crime?*

Yes
No

Please list the Date of your conviction or guilty plea, original charge, and disposition (penalty and/or time served).

EMPLOYMENT HISTORY

Past Employer #1

Company Name:

Address

City State / Province / Region

Phone

Supervisor Name:

OK to Contact:

Yes
No

Employed From:

Employed To:

Job Title:

Starting Pay Rate:

Ending Pay Rate:

Reason for Leaving:

Past Employer #2

Company Name:

Address

City State / Province / Region

Phone

Supervisor Name:

OK to Contact:

Yes
No

Employed From:

Employed To:

Job Title:

Starting Pay Rate:

Ending Pay Rate:

Reason for Leaving:

Past Employer #3

Company Name:

Address

City State / Province / Region

Phone

Supervisor Name:

OK to Contact:

Yes
No

Employed From:

Employed To:

Job Title:

Starting Pay Rate:

Ending Pay Rate:

Reason for Leaving:

REFERENCES

Reference #1

Name

Address

(Area Code) Phone

Occupation

Years known

Reference #2

Name

Address

(Area Code) Phone

Occupation

Years known

Reference #3

Name

Address

(Area Code) Phone

Occupation

Years known

Gold-Eagle Cooperative/CORN, LP

Applicant Notification and Release

As part of our hiring background and investigation, we may obtain consumer reports to prepare an investigative consumer report. The investigative consumer report may consist of contacting all listed prior employers to verify your employment history. It may also include, but not be limited to, credit information reports, criminal history reports and driving history records. Under the provisions of the Fair Credit Reporting Act (15 USC at 1681-1681u) as amended, before we can seek such reports, we must have your written permission to obtain the information. You have the right, upon written request, to a complete and accurate disclosure of the nature and scope of the investigation. You are also entitled to a copy of your Rights Under the Fair Credit Reporting Act.

Under the provisions of the Fair Credit Reporting Act, 15 USC, Section 1681 et seq., the Americans with Disabilities Act and all applicable federal, state, and local laws, I hereby authorize and permit Gold-Eagle Cooperative / CORN, LP to obtain a consumer report and/or an investigative consumer report which may include the following:

My employment records;
Records concerning any driving, criminal history, credit history, civil record, workers’ compensation (post-offer only) and drug testing;
(For truck drivers only) In accordance with the Department of Transportation Motor Carrier Safety Regulations, Section 382.413, information concerning alcohol and controlled substances for the past 2 years;
Verification of my academic and/or professional credentials; and information and/or copies of documents from any military service records.

I understand that an “investigative consumer report” may include information as to my character, general reputation, personal characteristics, and mode of living which may be obtained by interviews with individuals with whom I am acquainted or who may have knowledge concerning any such items of information.

I agree that a copy of this authorization has the same effect as an original.

I hereby release and hold harmless any person, firm, or entity that discloses matters in accordance with this authorization, as well as Gold-Eagle Cooperative / CORN, LP from liability that might otherwise result from the request for use of and/or disclosure of any or all of the foregoing information.

I understand and acknowledge that under provision of the Fair Credit Reporting Act I may request a copy of any consumer report from the consumer reporting agency that compiled the report, after I have provided proper identification.

I hereby authorize Gold-Eagle Cooperative / CORN, LP to obtain and prepare an investigative consumer report as set forth above, as part of its investigation of my employment application. This authorization shall remain in effect over the course of my employment. Reports may be ordered periodically during the course of my employment.

Electronic Signature*

Please enter your full name.

What is your contact info?

EDUCATION

School #1

School #2

School #3

SPECIAL TRAINING OR SKILLS

EMPLOYMENT HISTORY

Past Employer #1

Past Employer #2

Past Employer #3

REFERENCES

Reference #1

Reference #2

Reference #3

Gold-Eagle Cooperative/CORN, LP

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