Agri-Management Group - Agri-Business Jobs and Consulting

Prospective Employment Questionnaire — This information will be kept confidential.

Please note: We do not accept international applications at this time.
This form is for residents of the United States only. Thank you.

First Name:

Last Name:

Street Address:

City:

State:

Zip:

Phone Number:

Fax:

(If available)

E-mail:

Highest Level of Education:	High School Graduate	Tech or Vocational School
	2 Year College Degree	4 Year College Degree
	Graduate Degree

Can you supply references from previous employers?	Yes	No
Were you ever in the Armed Services?	Yes	No
Are you legally authorized to work in the United States?	Yes	No
Can you lift and carry 50 pounds?	Yes	No

Area of interest:	Dairy	Swine	Beef
	Livestock	Crops	Ag Business

Position desired:	Herdsperson	Assistant Herdsperson	Milker
	General worker	Mechanic/Fieldwork	Service/Support
	Fieldwork	Technical	Sales
	Other (describe):

What State(s) are you interested in working?

Were you raised on a farm?	Yes	No
Your ability to supervise others is:	Above average	Average	No experience
Marital Status:	Married	Single

Breifly describe your prior employment. Please include positions held, location, length of employment, job duties and reason for leaving:

List any other job-related experiences, skills, licenses, certifications or qualifications you would like us to consider:

Please read this statement carefully before submitting this questionnaire.

I certify the answers given and statements made in this questionnaire are true and correct. I hereby release previous employers or references from liability or damages incurred as a result of inquiry or furnishing information concerning my personal character and employment skills.

THIS IS NOT AN OFFER OR GUARANTEE OF EMPLOYMENT.

I HAVE READ THE ABOVE STATEMENTS AND UNDERSTAND THEM.

Phone: 608-221-3213
Toll Free: 1-800-551-9230
Fax: 608-221-3263
Email: info@agri-man.com

Dairy Farm Jobs | Herdsman Jobs | Agriculture Employment Service | Cow Farm Job

Website design company Web Studio West