Employment Application - CenDak Cooperative

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CenDak Cooperative

900 Railway Street South
P.O. Box 126
Fessenden, ND 58438-0126
Main Office: (701) 547-3291

Please complete the form below

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APPLICATION INFORMATION

*First Name:

*Last Name:

*Middle Initial:

Street Address:

Apartment/Unit #:

City:

State:

Zip:

*Phone:

*Email:

Position you are interested in:

*Date Available:

Now

Desired Salary:

*Are you a citizen of the United States?:

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.:

EDUCATION

High School:

Address:

From:

Now

To:

Now

Did you graduate?:

Yes No

Degree:

College:

Address:

From:

Now

To:

Now

Did you graduate?:

Yes No

Degree:

Other:

Address:

From:

Now

To:

Now

Did you graduate?:

Yes No

Degree:

REFERENCES

Please list three professional references

Full Name:

Relationship:

Company:

Phone:

Address:

Full Name:

Relationship:

Company:

Phone:

Address:

Full Name:

Relationship:

Company:

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Address:

PREVIOUS EMPLOYMENT

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary (numerical only) $:

Ending Salary (numerical only) $:

Responsibilities:

From:

Now

To:

Now

Reason for Leaving:

May we contact your previous supervisor for a reference?:

Yes No

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary (numerical only) $:

Ending Salary (numerical only) $:

Responsibilities:

From:

Now

To:

Now

Reason for Leaving:

May we contact your previous supervisor for a reference?:

Yes No

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary (numerical only) $:

Ending Salary (numerical only) $:

Responsibilities:

From:

Now

To:

Now

Reason for leaving:

May we contact your supervisor for a reference?:

Yes No

MILITARY SERVICE

Branch:

From:

Now

To:

Now

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

DISCLAIMER AND SIGNATURE

*Certify that your answers are true and complete to the best of your knowledge:

Yes

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Security Code

6001 60th Ave NE
Leeds, ND 58346
Main: (701) 466-2281

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