APPLICATION

FOR EMPLOYMENT

Dairyfood USA, Inc. • 2819 County Road F • Blue Mounds, WI 53517-9587 • P 608.437.5598 • F 608.437.4408

www.dairyfoodusa.com

Dairyfood USA, Inc. • 2819 County Road F • Blue Mounds, WI 53517-9587 • P 608.437.5598 • F 608.437.4408

www.dairyfoodusa.com

Dairyfood USA is an equal opportunity employer. We consider applications for all positions without regard to race, color, religion, creed, sex, national origin, age, disability, sexual orientation or any other legally protected status.

Last Name
/ First Name / M.I. / Position(s) Desired
Street Address / P.O. Box # / Availability
Full-time / Part-time / Seasonal
City / State / Zip Code / Shift Desired (select all that apply)
1st / 2nd / 3rd
Home Phone #
() - / Alternative Phone #
() - / Date Available (mm/dd/yy)
/ /
E-mail Address / Desired Pay Rate

REFERRAL SOURCE

Dairyfood USA Employee Referral – please provide name: / Organization reputation
Internet/Website / Former staff member / Newspaper: / Employment Agency
School: / Job Fair / Self/walk-in / Other:
Are you at least 18 years of age? / Yes No
Are you legally eligible for employment in the United States? / Yes No
Have you ever applied for employment at Dairyfood USA? If yes, give date... / Yes No
Have you ever been employed by Dairyfood USA? If yes, give position and employment dates: / Yes No
Position: / From (mm/yy): / To (mm/yy): /
Have you ever been disciplined or terminated from any position? If yes, please explain: / Yes No
Have you ever been convicted of a felony? (Conviction will not necessarily bar employment). / Yes No
Are your employment and/or educational records listed under any other name? – If yes, please list alias(es): / Yes No
Alias(es):
May we contact your current employer? / Yes No

MILITARY EXPERIENCE

Have you been in, or are you currently serving in the armed forces? / No Yes – If yes, please complete the following:
Branch: / Start date (mm/yy): / / End date (mm/yy): / / Type of Discharge:

EDUCATIONAL BACKGROUND

School / Name/Location / Course of Study / No. of years completed / Did you graduate? / Degree/Diploma or Certification
High School / Yes
No
College / Yes
No
Business/Trade/ Technical / Yes
No
Graduate / Yes
No

WORK HISTORY - Start with current or most recent job.

Position Title / Employment Dates: (mm/yy)
From: / To: /
Company Name / Starting Pay
/ Ending Pay
City/State / Phone Number
() - / Supervisor Name/Title
Description of Duties / Reason for Leaving
Position Title / Employment Dates: (mm/yy)
From: / To: /
Company Name / Starting Pay
/ Ending Pay
City/State / Phone Number
() - / Supervisor Name/Title
Description of Duties / Reason for Leaving
Position Title / Employment Dates: (mm/yy)
From: / To: /
Company Name / Starting Pay
/ Ending Pay
City/State / Phone Number
() - / Supervisor Name/Title
Description of Duties / Reason for Leaving

ADDITIONAL QUALIFICATIONS

Please list any other skills, training or experience you have had that you feel is relevant to the position for which you are applying:

WORK/PROFESSIONAL REFERENCES

List 3 individuals (no relatives) with whom you have worked that we may contact:
1. Name: / Relationship:
Day Phone: () - / Evening phone: () -
2. Name: / Relationship:
Day Phone: () - / Evening phone: () -
3. Name: / Relationship:
Day Phone: () - / Evening phone: () -

APPLICANT’S STATEMENT - Please read carefully before submitting this application.

w  I certify that information given is true and complete.
w  I understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this employer is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. I further understand that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
w  In the event that I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.
Print Name: / Date: /
Signature:

Dairyfood USA, Inc. • 2819 County Road F • Blue Mounds, WI 53517-9587 • P 608.437.5598 • F 608.437.4408

www.dairyfoodusa.com