Application Form

Bold fields are required.

Contact Information

Position Applied For:

Location:

Last Name:

First Name:

Middle Initial:

Address:

City:

State:

Zip/Postal Code:

Country:

How did you learn about this position? Advertisement Walk In Employee Internet Other:

How to Contact You? Phone Email

Email:

Phone:

Cell Phone:

Personal Information

Have you ever filed an application with us before? Yes No

If yes,

Have you ever been employed with us before? Yes No

If yes,

Are you related to any employees at KanEquip? Yes No

If yes,

Are you currently employed? Yes No

May we contact your current employer? Yes No

Available to Work:

Availability: Part-Time Full-Time

Desired Wage:

Can you travel if the position requires it? Yes No

Do you have a valid driver's license? Yes No

Do you have a valid CDL? Yes No

For purposes of compliance with the Immigration Reform and Control Act, are you legally eligible for employment in the United States? Yes No (Proof of citizenship or immigration status will be required upon employment.)

Have you been convicted of a crime other than a minor traffic offense in the last ten years? Yes No (A conviction does not necessarily disqualify an applicant from a particular position.)

If yes, please explain:

MILITARY SERVICE

Date Entered:

Date Discharged:

Branch of Service:

Reason for Discharge:

EDUCATION

High School:

Years Completed:

Diploma/Degree: Yes No

Type of Degree:

College/University:

Years Completed:

Diploma/Degree: Yes No

Type of Degree:

Technical/Professional:

Years Completed:

Diploma/Degree: Yes No

Type of Degree:

WORK HISTORY Please begin with your most recent employer.

Employer:

Address:

City:

State:

Zip/Postal Code:

Country:

Phone Number:

Dates of Employment:

Job Title:

Hourly Rate/Salary:

Supervisor:

Responsibilities:

Reason for Leaving:

Employer:

Address:

City:

State:

Zip/Postal Code:

Country:

Phone Number:

Dates of Employment:

Job Title:

Hourly Rate/Salary:

Supervisor:

Responsibilities:

Reason for Leaving:

Employer:

Address:

City:

State:

Zip/Postal Code:

Country:

Phone Number:

Dates of Employment:

Job Title:

Hourly Rate/Salary:

Supervisor:

Responsibilities:

Reason for Leaving:

RELEVANT EXPERIENCE

How long have you worked with farm equipment?

Do you have a farm background? Yes No

Have you worked for other dealers? Yes No

What Line?

Have you had experience with light industrial equipment? Yes No

As an operator? Yes No

Have you worked for other dealers? Yes No

What Line?

Have you had experience with outdoor power equipment? Yes No

What Line?

PROFESSIONAL REFERENCES

Name:

Title:

Phone Number:

Relationship:

Years Known:

Name:

Title:

Phone Number:

Relationship:

Years Known:

CHARACTER REFERENCES

Name:

Title:

Phone Number:

Relationship:

Years Known:

Name:

Title:

Phone Number:

Relationship:

Years Known:

SKILLS AND QUALIFICATIONS Summarize special job‐related skills and qualifications.

SPECIAL NOTE - PLEASE READ CAREFULLY

The facts set forth in my application for employment are true and complete. I understand that if employed, false statements on this application shall be considered sufficient cause for dismissal. You are hereby authorized to make any investigation of my personal history, driving record and financial and credit record through any investigative or credit agencies or bureaus of your choice. I also give permission to contact employers listed concerning work experience.

In making this application for employment, I authorize you to make an investigative consumer report whereby information is obtained through personal interviews with my neighbors, friends, or others with whom I am acquainted. This inquiry, if made, may include information as to my character, general reputation, personal characteristics and mode of living. I understand that I have the right to make a written request within a reasonable period of time to receive additional, detailed information about the nature and scope of any such investigative report that is made.

After employment, applicant agrees to comply with the Immigration Reform and Control Act of 1986, which requires proof of citizenship or alien status within three days of employment.

I verify the information entered and submitted is correct.

Since federal, state, and local laws and Interpretations of them change frequently, National Farm & Power Services, Inc. and any of its affiliates disclaim compliance with such laws. Users should refer any legal questions regarding this form to their legal counsel. This employment application is prepared for general use by equipment dealers and is intended to comply with all federal, state, and local fair employment practices laws and with the Fair Credit Reporting Act.

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