Application

Personal Information

First Name*

Middle Initial

Last Name*

Are you 18 or older?* Yes No

If under 18, when were you born?

Address*

City*

State*

ZIP*

Email*

Primary Phone*

Secondary Phone*

Introduction

Position Desired*

Have you applied at this company before?* Yes No

How did you hear about this position?

Hourly Rate/Salary Desired

Date Available*

Type of Position

Have you ever worked for Oregon Dairy before? Yes No

List friends and relatives employed by Oregon Dairy:

Activities (civic,athletic,etc):

Availability

How many evenings per week can you work?*

Approx. how many hours desired per week?*

Times available each day. (Saturday & Sunday hours required)

Sunday*

Monday*

Tuesday*

Wednesday*

Thursday*

Friday*

Saturday*

If you are hired, we will attempt to accommodate your schedule, but management reserves the right to schedule associates hours as necessary for store coverage and business reason, which may include weekends, evenings, and holidays.

Education

Education Background	Name of School	Years Completed	Graduated?	Course of Study
High School			Yes No
College			Yes No
Other			Yes No

General Information

Have you ever been discharged or asked to resign from any position? Yes No

If yes, explain:

How many days have you missed from school or work within the year other than approved vacation, sick or disability leave?

How many days have you been late from school or work within the year other than approved vacation, sick or disability leave?

Special Skills

US Military

Rank

Employment

Start with most recent

Employer Name

Phone

Job Title

Duties

Dates Employed

Hourly Rate/Salary

Supervisor

Reason for Leaving

Employer Name

Phone

Job Title

Duties

Dates Employed

Hourly Rate/Salary

Supervisor

Reason for Leaving

Employer Name

Phone

Job Title

Duties

Dates Employed

Hourly Rate/Salary

Supervisor

Reason for Leaving

Which of these jobs did you like best?

What did you like most about the job?

We are a service oriented business. What does good service mean to you?

As an employee, what do you expect from your co-workers, managers, and owners?

When we check your references, what do you think they will name as your greatest strength? As your greatest weakness?

If hired, what experience and knowledge do you expect to gain from working at Oregon Dairy?

References

Give the names of three persons not related to you, whom you have known at least one year.

	Name	Address & Phone Number	Occupation	Years Acquainted
1
2
3

In case of emergency, notify:

Name:

Phone #:

Knowledge/Skills/Abilities (KSAs)List KSAs WHICH YOU FEEL ARE RELEVANT TO THIS APPLICATION

"I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time.

In consideration of my employment, I agree to conform to the company's policies, and I understand that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than it's president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing."