Employment Application

 So you want to work for Original Grain?
Please send us an application!

Applicant Info

Your Name

First Name

Middle Inital

Last Name

Your Address

Street Address

Apt./Unit

City

State

Zip Code

Your Contact Info

Phone

Email


Position Details

What position are you applying for?

When can you start?

What is your desired salary?

Shift Hours

Please select all the shifts that you are available to work:

Breakfast 7am - 11am

Lunch 11am - 4pm

Dinner 4pm - 10pm

Late Night 10pm - 4am


Work History

Previous Employer (1 of 3)

Name of Company

Employed From

Employed To

Address of Company

Name & Title of Supervisor

Phone Number

Alternate Phone Number

Starting Position Title

Ending Position Title

Job Responsibilities

What was your reason for leaving?

May we contact this employer?
YesNo


Previous Employer (2 of 3)

Name of Company

Employed From

Employed To

Address of Company

Name & Title of Supervisor

Phone Number

Alternate Phone Number

Starting Position Title

Ending Position Title

Job Responsibilities

What was your reason for leaving?

May we contact this employer?
YesNo


Previous Employer (3 of 3)

Name of Company

Employed From

Employed To

Address of Company

Name & Title of Supervisor

Phone Number

Alternate Phone Number

Starting Position Title

Ending Position Title

Job Responsibilities

What was your reason for leaving?

May we contact this employer?
YesNo


Education

High School Attended

High School Address

Attended From

Attended To

Did you graduate?
YesNo

High School Degree


College Attended

College Address

Attended From

Attended To

Did you graduate?
YesNo

College Degree


Personal References

Reference (1 of 3)

Name

Phone Number

Number of years known

Origin of Relationship

May we contact this person?
YesNo


Reference (2 of 3)

Name

Phone Number

Number of years known

Origin of Relationship

May we contact this person?
YesNo


Reference (3 of 3)

Name

Phone Number

Number of years known

Origin of Relationship

May we contact this person?
YesNo


Additional Info

Military Service

Were you in the military?
YesNo

If so, please describe any military service you may have had.

Felony Disclosure

Have you ever been convicted of a felony, pled guilty to a felony resulting in a conviction, or been placed on probation for a felony offense?
YesNo

If so, please provide conviction details.
What was the date of the conviction?

What was the nature of the conviction?

Where were you convicted?

What was the disposition?

Note: A conviction will not necessarily disqualify an applicant for employment, but date and type of conviction may be considered for job placement.

Referral Source

How were you referred to us?
AdvertisementEmployeeRelativeWalk-inGovernment Employment AgencyOther

If other, please explain how you found us?

Safety Rules

If hired, will you abide by the safety rules of this company?
YesNo


Resume

Please attach a copy of your resume (PDF or TXT format accepted).

Terms & Conditions Agreement

PLEASE READ THE FOLLOWING CAREFULLY AND ACCEPT THE TERMS

In compliance with Federal and State equal employment opportunity laws, it is this company's intention to consider all applicants without regard to race, color, religion, sex, national origin, age, marital status, disability, the presence of non-job related medical conditions, or any other protected classification.

I declare that I am qualified to perform all the duties of the position I am seeking. I also declare that the information I have provided on this application is correct and that any faults statements or omissions will justify my rejection or dismissal. I authorize the company to contact any of my previous employers as well as any reference source to verify the facts and information I have furnished regarding information provided on this application, on my resume, or during my interview. I authorize any person(s) having knowledge to provide such information to the company, and release from liability and agreed to hold harmless any person(s) that furnishes such information in good faith, as allowed by applicable state and federal laws. I will agree to a drug test, if permitted by law, to be paid for by the company. Should I become involved in a claim for worker's compensation or any other litigation after employment by the company, I will allow the company to supply my employment records (as allowed by applicable state and federal laws to an opposing party. If employed by the company, I understand that I will be an employee at will and my employment with Original Grain or any of its subsidiaries or affiliates, may be terminated at any time by myself or Original Grain for any reason whatsoever. Should I become employed at Original Grain, I also authorize Original Grain to conduct any additional background checks should they become necessary at any point during my employment. Finally, I understand that this is only an application for employment and either an offer of or a contract of employment and no part of this application shall be construed as an offer of employment or an employment contract. The Agreement to Arbitrate accompanying this application must be read and signed in order for you to be considered for employment with Original Grain or any of its related companies. By signing the Agreement to Arbitrate I understand that the employment at will relationship will not be altered.

Do you accept these terms?

Please leave this field empty.