Employment Application

APPLICANT NOTE:  This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, color, age, creed, national origin, sexual orientations, military reserve membership, ancestry, religion, height, weight, physical handicap, or the presence of disabilities. A felony conviction will not necessarily bar an applicant from employment. Additional testing of job-related skills and for the presence of drugs in your body may be required prior to employment. After an offer of employment, and prior to reporting to work, you may be required to submit to a medical review. Depending on the needs of the job, you may be required to complete a medical history form and you may be required to be examined by a medical professional designated by the company.

Street, City, State, and ZIP
Street, City, Sate, and ZIP


NOTE: Do not fill out any part of this section you believe to be non-job related.


If so, please describe in the boxes below. (Conviction will not necessarily be a bar to employment. In accordance with company policy and applicable state and federal laws, factors such as age at time of the offense, remoteness of the offense, time since last conviction, nature of the job sought and rehabilitation effort will be reviewed.)


**Complete this section only if applying for a driving position, or if you currently hold a commercial drivers license.

Drivers Licenses Held In Past 3 Years Must Be Shown.

Driving Experience

(Van, Tank, Flat, etc.)


NOTE: do not fill out any part of this section you believe to be non -job related.


– Please provide a minimum of 5-year employment history


Company Name, City, and Sate
Time started to end or current
Include per (hour, week, or month)
Company Name, City, and Sate
Time started to end or current
Include per (hour, week, or month)


Include only individuals familiar with your work ability. Do not include relatives.

I certify that I have read and understand the applicant note on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejections of my application or discharge at any time during my employment. I authorize the company and / or its agents, including consumer reporting bureaus, to verify any of this information. I authorize all former employers, persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.  Furthermore, I understand that should an offer of employment be extended and accepted, such employment is “at will” and does not express or imply an employment contract.


Battle Creek Farmer’s Cooperative N/S (hereafter Farmers Pride) may procure a consumer report or investigative consumer report as defined in 15 USC 1681a of the Fair Credit Reporting Act (FCRA) for the purpose of evaluating the undersigns’ application for employment. Pursuant to the federal Fair Credit Reporting Act, I hereby authorize Farmers Pride and its designated agents and representatives to conduct a review of my background through a consumer report and/or an investigative consumer report to be generated for employment, promotion, reassignment or retention as an employee or job applicant. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: verification of Social Security number; current and previous residences; employment history, including all personnel files; education; references; credit history and reports; criminal history, including records from any criminal justice agency in any or all federal, state or county jurisdictions; motor vehicle records, including traffic citations and registration; and any other public records.
I, ________________________________, authorize the complete release of these records or data pertaining to me that an individual, company, firm, corporation or public agency may have. I hereby authorize and request any present or former employer, school, police department, financial institution, consumer reporting agency as defined in 15 U.S.C. 1681a(e), and other persons having personal knowledge of me to furnish Farmers Pride or its designated agents with any and all information in their possession regarding me in connection with my application of employment. I am authorizing that a photocopy of this authorization be accepted with the same authority as the original.

I understand that, pursuant to the federal Fair Credit Reporting Act, if any adverse action is to be taken based upon the consumer report, a copy of the report and a summary of the consumer's rights will be provided to me.

NOT initial - if none, mark "N/A"
(e.g. Maiden Name)
NOT initial - if none, mark "N/A"
Street, City, State, and ZIP
Street, City, State, and ZIP

The undersigned’s application for employment cannot be processed by Farmers Pride until this disclosure and authorization is completed and signed.