Application for Employment

Michlig Grain, LLC.is an equal opportunity employer.

Personal Information Date:______

Name Social Security Number

Street Address City StateZip Code

Phone NumberMessage Phone/Cell Phone E-Mail Address

Are you legally authorized to work in the United States? Yes No

Employment Desired

PositionDate You Can StartSalary Desired

Have You Applied With Us Before?When?

Type of Employment Desired Full-time Part-time Seasonal/Temporary

Do you have any objection to working over time if necessary? Yes No

Can you travel if required by this position? Yes No

Have you worked with this company before? Yes No

Drivers License Number: ______

How were you referred to us? ______

Previous Employment(please include all employment during last 10 years; use additional sheets, if necessary)

Start Date End DateEmployerName & LocationPhone Number
Position & DutiesReason For Leaving
Starting SalaryEnding SalarySupervisor’s Name
If Current Employer May We Contact? Yes No
Start Date End DateEmployerName & LocationPhone Number
Position & DutiesReason For Leaving
Starting SalaryEnding SalarySupervisor’s Name
Education History

Name of High SchoolLocationDegree Earned

College/Trade SchoolLocationDegree Earned

General Information

Special Skills or Training

Have you ever been convicted of a felony? No Yes If yes, provide offenses, dates and location:*

______

______

*Applicantsare not obligated to disclose arrests that did not result in conviction, or convictions sealed or expunged by court order.

References

NameRelationship to YouYears KnownPhone Number

NameRelationship to YouYears KnownPhone Number

NameRelationship to YouYears KnownPhone Number

Authorization

I certify that the facts contained in this application are true and complete to the best of my knowledge. I further understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I understand that the pre-employment screening process may include a criminal background investigation, reference check and employment history verification. I expressly consent to the pre-employment screening process. I understand that the necessary information to complete the process may include birth date, social security number, maiden names and other such personal identification information, and agree to provide such information necessary to complete the process.

Unless I have expressly indicated that a previous or current employer may not be contacted, I agree that my previous employers may release qualitative information, including but not limited to my quality of work, productivity, attendance, reliability and working relationships, and waive written notice regarding the release of such information. I further agree to hold my previous employers harmless from any liability for statements made to Michlig Grain, LLC.about my previous job performances. I authorize investigation of all other statements contained herein.

I also understand and agree that employment with Michlig Grain, LLC. is at-will and no representative of the company has the authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the at-will status.

SIGNATURE: ______DATE:______

Revised 4/12