Employment Application – D&K Agri-Sales

Thank you for your interest in working at D&K Agri-Sales. This application consists of seven sections – please fill out each section as completely as possible.

DISCLOSURE REGARDING BACKGROUND INVESTIGATION
D&K Agri-Sales (“The Company”) may obtain information about you from a consumer reporting agency for employment purposes. Thus, you may be the subject of a “consumer report” and/or an “investigative consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living, which can involve personal interviews with sources such as your neighbors, friends, or associates. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records (“driving records”), verification of your education or employment history including current position, worker’s compensation injuries, or other background checks. You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report conducted by [One Source The Background Check Company, PO Box 24148, Omaha, NE 68124, 1.800.608.3645, www.onesourcebackground.com]. The scope of this notice and authorization is allowing the Company to obtain from any outside organization all manners of consumer reports and investigative consumer reports now and throughout the course of your employment to the extent permitted by law.

SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT
A summary can be found on page 13 of the OneSource Applicant Disclosure and Authorization form. For more information, see: https://www.consumerfinance.gov/learnmore/

1. Applicant information

First name (required)

Last name (required)

Middle

Other names/Alias

Social Security # (required)

Date of birth (required)

Street address (required)

Street address (line 2 - Apartment/Unit, etc.)

City (required)

State (required)

ZIP (required)

Phone (required)

Email (required)

Date available (required)

Desired salary

Position applied for (required)

Are you a citizen of the United States? (required)
YesNo

If no, are you authorized to work in the U.S.?
YesNo

Do you have a current and valid driver's license? (required)
YesNo

Driver's license state

Driver's license #

Driver's license expiration

Do you have a CDL?
YesNo

Have you ever been convicted of a felony? (required)
YesNo

If yes, explain

Please list all previous addresses you have had in the last seven (7) years (if applicable)

2. Education

High School

High School (required)

Street address (required)

Street address (line 2)

City (required)

State (required)

ZIP (required)

From (required)

To (required)

Did you graduate? (required)
YesNo

College

College

Street address

Street address (line 2)

City

State

ZIP

From

To

Did you graduate?
YesNo

Degree

Other

Other

Street address

Street address (line 2)

City

State

ZIP

From

To

Did you graduate?
YesNo

Degree

3. References

Please list three professional references. Please DO NOT include relatives.

Reference #1

Full Name (required)

Relationship (required)

Company (required)

Phone (required)

Address (required)

Reference #2

Full Name (required)

Relationship (required)

Company (required)

Phone (required)

Address (required)

Reference #3

Full Name (required)

Relationship (required)

Company (required)

Phone (required)

Address (required)

4. Previous Employment

Employer #1

Company

Phone

Address

Supervisor

Job Title

Starting Salary (if known)

Ending Salary (if known)

Responsibilities

From

To

Reason for Leaving

May we contact your previous employer for a reference?
YesNo

Employer #2

Company

Phone

Address

Supervisor

Job Title

Starting Salary (if known)

Ending Salary (if known)

Responsibilities

From

To

Reason for Leaving

May we contact your previous employer for a reference?
YesNo

Employer #3

Company

Phone

Address

Supervisor

Job Title

Starting Salary (if known)

Ending Salary (if known)

Responsibilities

From

To

Reason for Leaving

May we contact your previous employer for a reference?
YesNo

5. Military Service

Branch

From

To

Rank at Discharge

Type of Discharge

If other than honorable, please explain

6. Anything else?

If there's anything else you'd like to tell us about yourself, please enter it below

7. Disclosure and Authorization

I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by the Company at any time after receipt of this authorization and throughout my employment, if applicable. I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original.

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature (Type in your full name – required)

Date (required)