Yost Farm Supply

APPLICATION FORM

Date of Application Store Location

Name *

Home Phone Cell * Email *

Address * City *

State * Zip * How long have you resided at this address?

Position(s) Applied for * Referral Source

Date Available for Employment * Are you available to work

Full-Time Part-Time Over-Time

If employed and under 18, can you furnish a work permit?

Yes No

Do you have the legal right to work in the United States?

Yes No

Have you worked for this company before?

Yes No

If yes, please specify below

Date From: Date To: Rate of Pay Position

Location* Reason for leaving

Are you currently employed

Yes No

If not, how long since leaving last employment?

May we contact your present employer?

Yes No

Rate of pay expected

Is there any reason you might be unable to perform the essential functions of the job for which you have applied?

Yes No

If yes, explain if you wish.

Have you been convicted of a felony?

Yes No

(Please note that a “yes” will not bar you from consideration for employment.)

If yes, please explain

Employment History

(NOTE: List employers in reverse order starting with the most recent.)

Employer 1

Address

City State Zip

Supervisor's Name Phone Number May we contact?
Yes No

Employed From Employed To

Position Held Salary/Wage

Duties

What do you like most about your job?

Reason for leaving?

Employer 2

Address

City State Zip

Supervisor's Name Phone Number May we contact?
Yes No

Employed From Employed To

Position Held Salary/Wage

Duties

What do you like most about your job?

Reason for leaving?

Employer 3

Address

City State Zip

Supervisor's Name Phone Number May we contact?
Yes No

Employed From Employed To

Position Held Salary/Wage

Duties

What do you like most about your job?

Reason for leaving?

Employer 4

Address

City State Zip

Supervisor's Name Phone Number May we contact?
Yes No

Employed From Employed To

Position Held Salary/Wage

Duties

What do you like most about your job?

Reason for leaving?

Education

High School

Name Address

Grade Completed
9 10 11 12

College

Name Address

Years Completed
1 2 3 4 Course of Study

Graduate School

Name Address

Years Completed
1 2 3 4 Course of Study

Special skills, qualifications and considerations

Summarize special skills and qualifications, volunteer activities, military experience, employment or other activities related to the job you are seeking:

References

List three (3) non-relatives who are familiar with your qualifications, work history and ability.

Name Occupation Years Known Telephone Number

All Applicants

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE SIGNING THIS APPLICATION. ONLY THOSE APPLICATIONS THAT ARE SIGNED AND DATED ARE CONSIDERED VALID. IF YOU HAVE ANY QUESTIONS REGARDING THIS STATEMENT, PLEASE ASK A COMPANY REPRESENTATIVE BEFORE SIGNING.

I certify that all answers and statements I have made on this Application (and resume or other supplementary materials) are true and complete without omissions. By signing below, I authorize YOST FARM SUPPLY to investigate all statements contained in this Employment Application as they may deem necessary in arriving at an employment decision. I understand that any false information provided by me will likely result in a refusal to hire or immediate discharge if I am employed. I authorize any of the persons or organizations named in this Application to give you complete information and records regarding my employment, education, character and qualifications.

If hired, I will be responsible for familiarizing myself with all rules, regulations and policies of YOST FARM SUPPLY as they presently exist or are later modified. If hired, I understand my employment can be terminated, at the discretion of YOST FARM SUPPLY or at my option, without notice, at any time and for any reason.

I also understand that no representative of YOST FARM SUPPLY has any authority to enter into any employment agreement for any specified period of time, or to assure me of any future position, benefits, or terms and conditions of employment, except as specifically stated in a current written agreement signed by the president of YOST FARM SUPPLY.

I understand this application is not an offer of employment and no promises or representations of employment have been made to me at this time.

By selecting the "I Accept" button below, you are signing this Employment Application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Application.

I Accept

Signature of Applicant * Date

This application is valid for only ninety (90) days from the date signed. To be considered for job openings more than ninety (90) days from date signed, a new application will need to be submitted.

For security purposes, please enter the characters from the box above:

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APPLICATION FORM

Employment History

Education

Special skills, qualifications and considerations

References

All Applicants