Employment Application
Stolzenburg Harvesting
Complete this form to submit an application to us.
Please print this page for your records.
* denotes required areas of the application.
* Name:
* Address:
* City:
* State:
* Zip Code:
* Country:
* Phone number we can reach you during the day:
E-mail Address:
Marital Status:
Single
Married
Divorced
Widowed
Age:
Do you speak and understand English?
Yes
No
* Do you have a valid drivers licence?
Yes
No
If yes, is it a commercial licence?
Class A
Class B
Class C
D.L. Number:
Issuing State:
* Have you had any traffic violations within the last three years?
Yes
No
* Have you ever been charged with driving while intoxicated?
Yes
No
If yes, please explain:
Do you consume alcohol?
Frequently
Occasionally
Not at all
Do you smoke or use other tobacco products?
Yes
No
Do you have any experience with farm or harvesting equipment?
Yes
No
Check Yes or No for each type of the following equipment you have operated:
Grain Harvester (combine) Yes
No
Field Tractor Yes
No
Grain Cart Yes
No
Grain Truck (single axle) Yes
No
Heavy Truck (Semi-tractor-trailer) Yes
No
Do you have any experience with these job skills?
Auto, truck or farm equipment repair
Welding
Electrical
Computer skills
Machine repair
Any other job skills you may have please describe them here:
We start our harvest run in May and continue through December,
would you be able to stay with us thru the entire season?
Yes
No
Do you feel you are able to take responsibility for your actions?
Yes
No
Do you enjoy travelling?
Yes
No
Do you have an open mind?
Yes
No
Do you enjoy working with others and get along with them?
Yes
No
Do you enjoy doing agricultural work?
Yes
No
Do you plan on making a career in agriculture?
Yes
No
Are you willing to work long hours?
Yes
No
Do you have any type of disability that prevents you from performing manual labor,
such as lifting up to 75 lbs occasionally?
Yes
No
Personal references:
( 3 required)
Name:
Phone number:
Relationship:
Name:
Phone number:
Relationship:
Name:
Phone number:
Relationship:
EMPLOYMENT HISTORY:
List as many employers as possible starting with most recent.
EMPLOYER:
JOB TITLE:
CITY:
STATE:
SUPERVISOR:
PHONE:
DATES:
From (MM/DD/YYYY)
To: (MM/DD/YYYY)
Please list your duties while employed there:
EMPLOYER:
JOB TITLE:
CITY:
STATE:
SUPERVISOR:
PHONE:
DATES:
From (MM/DD/YYYY)
To: (MM/DD/YYYY)
Please list your duties while employed there:
EMPLOYER:
JOB TITLE:
CITY:
STATE:
SUPERVISOR:
PHONE:
DATES:
From (MM/DD/YYYY)
To: (MM/DD/YYYY)
Please list your duties while employed there:
EMPLOYER:
JOB TITLE:
CITY:
STATE:
SUPERVISOR:
PHONE:
DATES:
From (MM/DD/YYYY)
To: (MM/DD/YYYY)
Please list your duties while employed there:
EMPLOYER:
JOB TITLE:
CITY:
STATE:
SUPERVISOR:
PHONE:
DATES:
From (MM/DD/YYYY)
To: (MM/DD/YYYY)
Please list your duties while employed there:
EMPLOYER:
JOB TITLE:
CITY:
STATE:
SUPERVISOR:
PHONE:
DATES:
From (MM/DD/YYYY)
To: (MM/DD/YYYY)
Please list your duties while employed there:
EMPLOYER:
JOB TITLE:
CITY:
STATE:
SUPERVISOR:
PHONE:
DATES:
From (MM/DD/YYYY)
To: (MM/DD/YYYY)
Please list your duties while employed there:
Any information supplied on this form is subject to verification.
All information collected on this site will be kept confidential.