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Employment Application

How did you hear about us?
- Advertisement
- Internet Site
- Job Fair/Recruiting Event
- Referral
Personal Information
Position Applied For:*
Name*
First Last
Address*
Street Address City State ZIP Code
Phone*
Email
Are you 18 years or older?*
If applying for a position that requires driving, please provide driver's license number:
General Information
Have you ever been employed by River Country Cooperative before?*
At which location?
Reason for leaving:
If hired, can you provide proof that you are eligible to work in the United States?*
Education History
Name of high school:
Did you graduate?
Name of college or university:
Major:
Did you graduate?
What did you attain?
- Degree/Diploma
- Certificate
Name of graduate school:
Major:
Did you graduate?
Technical, Business or Vocation Training:
Course of study:
What did you attain?
- Degree/Diploma
- Certificate
Any job related seminars, short courses, workshops, or other education experiences:
Employment History
Include employment information from your last three employers with start and end dates, beginning with the most recent. If you have a gap in employment, please explain below, including dates. Failure to provide complete information may result in rejection of your application.
May we contact your present employer?
Company name:
Job title and duties
Address
Street Address City State ZIP Code
Supervisor name (required):
Phone
Dates employed (from - to):
Reason for leaving:
Final wage/salary:
Company name:
Job title and duties
Address
Street Address City State ZIP Code
Supervisor name (required):
Phone
Dates employed (from - to):
Reason for leaving:
Final wage/salary:
Company name:
Job title and duties
Address
Street Address City State ZIP Code
Supervisor name (required):
Phone
Dates employed (from - to):
Reason for leaving:
Final wage/salary:
Special skills and qualifications:
Additional information you would like us to consider in evaluating your qualifications:
Explain any gaps in employment here:
References
List TWO current or past individuals who have supervised/managed you. An HR Manager will also be acceptable. You may list one personal reference. DO NOT INCLUDE RELATIVES.
Name
First Last
Company and title:
Phone
Name
First Last
Company and title:
Phone
Name
First Last
Company and title:
Phone
AGREEMENT – Please read statement carefully
I certify that the facts set forth in this application are true and complete, to the best of my knowledge. I acknowledge that River Country Cooperative (hereafter referred to as “THE COMPANY”) may rely on my representations in this application in making its hiring decision. I understand that any false statement or omission of information on this application may result in my not being hired or, if discovered later, my immediate discharge.

I authorize investigation of all statements contained herein and authorize the references and previous employers listed above to give THE COMPANY any and all information requested concerning my previous employment and any pertinent information they may have, personal or otherwise. I understand that the results of such an investigation may be used to determine whether I will be hired. I hereby release said references, investigators, previous employers and THE COMPANY from all liability for any damage that may result from furnishing or receiving this information.

I further agree that, if employed, I will conform my conduct to THE COMPANY rules and understand that my employment is “at will” and can be terminated with or without cause, and with or without notice, at any time, at my option or the option of THE COMPANY. I also understand that this application and any employment manuals or handbooks that may be distributed to me during my employment shall not be regarded as a contract.

In the event of termination of my employment, whether voluntary or involuntary, I authorize THE COMPANY, in its sole discretion, to supply my name, address and phone number to other divisions, companies, services or agencies which may have employment opportunities.
Enter your initials signifying agreement to the terms above:*

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