Apply - Northern Country Coop

Position Applying For *

Personal Information

Name *

First

Middle

Last

Phone *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Are you 18 years of age or older? *

Yes
No

List any other names that you have previously used to identify yourself, and identify the period of time that you used the name.

Are you legally eligible to work in the U.S.? *

Yes
No

(If offered employment, eligibility documentation must be produced within 3 work days)

Have you previously been employed with Northern Country Cooperative? *

Yes
No

If yes, you have been previously employed with NCC, please indicate dates, position held, department/location, and your reason for leaving.

How were you referred to us?

Type of Employment desired: *

Full-Time
Part-Time
Temporary
Seasonal

Check all that apply.

Do you have any objection to working weekends and/or overtime if necessary? *

Yes
No

Can you travel if required by this position? *

Yes
No

Education

Name of High School

Graduated High School?

Yes
No

Degree Earned

Diploma
GED

Name of College Attended (If Applicable)

Major Course of Study in College (If Applicable)

Number of Years

Graduated College? (If Applicable)

Yes
No

Degree Earned (If Applicable)

Associates
Bachelors
Other

Please list any other education opportunities pursued or graduate school, if any.

Work Experience

List either your last four (4) places of employment or up to ten (10) years of employment history, starting with your present or most recent employer. Please respond to the following information completely. A resume may be included for additional reference.

Upload Resume

Click or drag a file to this area to upload.

Company Name #1 (Present or Former Employer - List most recent first.)

Dates of Employment (From M/Y to M/Y)

Job Title/Position

Address

Address Line 1

Address Line 2

City

State

Zip Code

Reason for Leaving (If not still currently employed there.)

Name of Supervisor

First

Last

Phone Number

May we contact for a reference?

Yes
No

If no, why not?

Job Duties/Responsibilities

Hours Per Week & Wage

Company Name #2

Dates of Employment (From M/Y to M/Y)

Job Title/Position

Address

Address Line 1

Address Line 2

City

State

Zip Code

Reason for Leaving

Name of Supervisor

First

Last

Phone Number

May we contact for a reference?

Yes
No

If no, why not?

Job Duties/Responsibilities

Hours Per Week & Wage

Company Name #3

Dates of Employment (From M/Y to M/Y)

Job Title/Position

Address

Address Line 1

Address Line 2

City

State

Zip Code

Reason for Leaving

Name of Supervisor

First

Last

Phone Number

May we contact for a reference?

Yes
No

If no, why not?

Job Duties/Responsibilities

Hours Per Week & Wage

Company Name #4

Dates of Employment (From M/Y to M/Y)

Job Title/Position

Address

Address Line 1

Address Line 2

City

State

Zip Code

Reason For Leaving

Name of Supervisor

First

Last

Phone Number

May we contact for a reference?

Yes
No

If no, why not?

Job Duties/Responsibilities

Hours Per Week & Wage

Professional References

Provide the names of three references familiar with your current skills and abilities. Please do not include supervisors listed in the Work Experience section or family members.

Reference #1

First

Last

Company Name

Phone

Relationship & Years Known

Reference #2

First

Last

Company Name

Phone

Relationship & Years Known

Reference #3

First

Last

Company Name

Phone

Relationship & Years Known

Driver's License Considerations

If the position you are applying for requires it, do you have a valid driver's license? *

Yes
No
N/A

Do you have a Commercial Driver's License? (CDL) *

Yes
No

If yes, list any CDL endorsements:

Have you ever had any license suspended or revoked? *

Yes
No

If yes, state the type of license, the regulatory agency or body making the suspension/revocation, the date(s) of suspension/revocation, and the reason for the suspension/revocation:

Closing Remarks & Submission

I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information. I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered. If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law. I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that persons need for a reasonable accommodation as required by the ADA. I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment.

I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions:

Applicant Signature *

First

Last

Date *

Northern Country Cooperative - An Equal Employment Opportunity Employer

This company does not unlawfully discriminate in hiring or any aspect of the employment relationship on the basis of age, race, color, sex, religion, national origin, disability, or any other basis protected by law in the jurisdiction in which the employment is performed.

Application For Employment – General

Personal Information

Education

Work Experience

Professional References

Driver's License Considerations

Closing Remarks & Submission

I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions:

Northern Country Cooperative - An Equal Employment Opportunity Employer

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