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About Us
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Staff
Contact

Employment Application

Name *

First

Middle

Last

Street Address *

Apartment / Unit #

City *

State *

Zipcode *

Phone *

Email *

Date Available *

Desired Salary: *

Position Appling For: *

Are you a citizen of the United States? *

Yes
No

If "No" are you authorized to work in the U.S.?

Yes
No

Have you ever worked for this company? *

Yes
No

If "Yes", when?

Have you ever been convicted of a felony? *

Yes
No

If "Yes", explain:

~ HIGH SCHOOL EDUCATION ~

High School Name *

High School Address *

What years where you in High School?

Did you graduate? *

Yes
No

Diploma:

~ COLLEGE EDUCATION INFO ~

College Name:

College Address:

What years did you attend this College?

Did you graduate?

Yes
No

Degree:

~ ADDITIONAL EDUCATION INFO ~

Other Education (Name of Organization)

Other Education Address

What years did you attend Other Education?

Did you graduate?

Yes
No

Degree:

~ REFERENCES: Please list three professional references ~

Reference 1 Name *

First

Last

Relationship *

Phone Number *

Company *

Address:

~ REFERENCE 2 ~

Reference 2 Name *

First

Last

Relationship *

Phone Number *

Company *

Address:

~ REFERENCE 3 ~

Reference 3 Name *

First

Last

Relationship *

Phone Number *

Company *

Address:

~ PREVIOUS EMPLOYMENT ~

Company Name

Phone Number

Address

Supervisor's Name

First

Last

Starting Salary

Ending Salary

Job Title

Responsibilities:

Start Date

End Date

May we contact your previous supervisor for a reference?

Yes
No

Reason For Leaving:

~ 2ND PREVIOUS EMPLOYMENT ~

2nd Previous Company Name

Phone Number

Address

Supervisor's Name

First

Last

Starting Salary

Ending Salary

Job Title

Responsibilities:

May we contact your previous supervisor for a reference?

Yes
No

Start Date

End Date

Reason For Leaving:

~ 3RD PREVIOUS EMPLOYMENT ~

Company Name

Phone Number

Address

Supervisor's Name

First

Last

Starting Salary

Ending Salary

Job Title

Responsibilities:

May we contact your previous supervisor for a reference?

Yes
No

Start Date

End Date

Reason For Leaving:

~ MILITARY SERVICE ~

Branch:

Start Date:

End Date:

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

~ DISCLAIMER AND SIGNATURE ~

I certify that my answers are true and complete to the best of my knowledge. I understand that if I am employed by Northwest Missouri Industries, Inc., employment is “at will” which means that employment is not for a definite period and may be terminated either myself or Northwest Missouri Industries Inc, in the sole discretion of either, for any reason, at any time. I understand that if employed by Northwest Missouri Industries. Inc., that the satisfactory completion of my inductor period will not change my status as an “at will” employee.I hereby authorize Northwest Missouri Industries, Inc. to obtain from companies, institutions or individuals it contacts, any information in their possession regarding my employment history or qualifications for the job which I have applied and release the same from liability resulting from providing such information.I certify that I have never been terminated from employment or convicted of a crime due to unauthorized physical contact, abuse or neglect of a child or an elderly person. I certify that the statements and answers made on this application for employment with Northwest Missouri Industries, Inc. are true, correct and completeand hereby grant Northwest Missouri Industries, Inc. to verify the information provided. I understand the submission of false information or failure to submit complete information requested herein shall constitute grounds, among others, for rejection of my applicationor immediate termination in the event that I am hired. *

I have read and understand the above disclaimer / statement and that this is my digitial signiture.