Royal Crest Dairy
Employment Application

INTRODUCTION

An Equal Opportunity Employer

We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors.

SECTION I   General Information (use name that appears on Social Security)
Position Applying for:
Are you seeking: Full-time   Part-time  Temporary
Name: (Last, First, Middle)
Email Address:
Date:
Address: (Number and Street, City, State, Zip)

How long have you lived at this address?
Previous address:

Telephone Number:
Social Security Number:
Have you been previously employed by Royal Crest Dairy?:  Yes No  
If yes, when? What Position?
SECTION II   Personal Information

Do you have the legal right to work in the United States? Yes No
You will be required to complete and comply with Employment Eligibility Verification Form I-9.
Have you ever been convicted of any law violation? (Include any plea of "guilty" or "no contest." Exclude minor traffic violations.) Yes No  
If yes, give details:

(A conviction will not necessarily disqualify an applicant for employment.)

List any relations of yours, by blood or marriage, who are employed by Royal Crest Dairy. Indicate each person's relationship to you and their position:

Who referred you?

SECTION III   Driving Information*

* Complete only if applying for driving or sales position.

State issuing driving license:
Type of license:
License Number:
Expiration date:
Types or vehicles operated:
Have you been charged with any traffic violations in the 
past three years? Yes No  
If yes, give details of each violation:

Please give dates and reasons for any license suspension you have had:

Note: If you are considered for employment in a driving position with Royal Crest Dairy, you will be required to furnish a current State of Colorado record of your driving history prior to your employment. Employment is contingent upon Royal Crest Dairy's approval of your driving record. After employment, your driving record will be periodically checked with the State of Colorado. Violations of state traffic laws and regulations may result in your termination.

SECTION IV   Military Experience
Indicate any experience, education, or special skills that you gained from serving in the Armed Forces of the United States.

In which branch of the Armed Forces did you gain this experience, education, or skill?:
Date of entry in military service:
Date of separation from military service:
Do you belong to the Reserves or National Guard?  Yes No  
Section V   Education, Skills and Training
Indicate the highest level of education you have fully completed:
Provide details on your education and training, include Name and Location, Course of Study, Credit/Seminar Hours Earned and Degree or Certificate Earned for:

High School

College/University

University Graduate Study

Business/Correspondence/Trade/Tech
Section VI   Special Skills
What skills or additional training do you have that are related to the job for which you are applying?

What machines or equipment can you operate that are related to the job for which you are applying?
Section VII   Work History - General
Have you filed an application with Royal Crest Dairy before? Yes No  
If yes, give date:
For What Position?
Have you ever been discharged, dismissed, or requested 
to resign from any job? Yes No  
 If you have, please explain the circumstances:

Are you on a lay-off and subject to recall? Yes No  
Are you presently employed? Yes No  
May we contact your present employer(s) for reference 
information? Yes  No  
 If not, please explain why:
Section VIII   Work History - Specific (Last Five Years of Employment)

You MUST identify last Five Years of employment.
If you have not been in the workforce for five years, acknowledge so.
List any other name(s) under which you have been employed.
This information will assist us in doing reference checks.

WORK HISTORY

List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references.

Note: A job offer may be contingent upon acceptable references from current and former employers.

Employer (Include Name, Address, City, State, Zip Code and Telephone)

Supervisor(s):
Employment Dates:
From: (mo/yr)
To: (mo/yr)
Pay: Start $ Final $
Title:
Reason for Leaving:
Duties:

Employer (Include Name, Address, City, State, Zip Code and Telephone)

Supervisor(s):
Employment Dates:
From: (mo/yr)
To: (mo/yr)
Pay: Start $ Final $
Title:
Reason for Leaving:
Duties:

Employer (Include Name, Address, City, State, Zip Code and Telephone)

Supervisor(s):
Employment Dates:
From: (mo/yr)
To: (mo/yr)
Pay: Start $ Final $
Title:
Reason for Leaving:
Duties:

Employer (Include Name, Address, City, State, Zip Code and Telephone)

Supervisor(s):
Employment Dates:
From: (mo/yr)
To: (mo/yr)
Pay: Start $ Final $
Title:
Reason for Leaving:
Duties:

This application for employment will remain active for a limited time. Ask the organization's representative for details.

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may not be published, rewritten, or redistributed without 
prior permission.
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