Fields marked with an asterisk (*) must be filled out before submitting.

Personal Details

First Name *
Last Name *
Email Address *
Address *
City *
State *
Zip Code *
Telephone # *
Date Available To Start
Desired Salary
If hired, can you submit verification of your legal right to work in the U.S.? * Yes
No
If no, are you authorized to work in the US? Yes
No
Have you ever worked for D&L Farm and Home? Yes
No
If yes, when?
 

Education

High School
High School City, State
Did you graduate? Yes
No
College
College City, State
Did you graduate? Yes
No
Degree/Area of study
 
Other (Technical school, etc)
Other City, State
Did you graduate Yes
No
Degree/Area of Study
 

Reference #1

Full Name
Company
Relationship
Phone Number
Address
 

Reference #2

Full Name
Company
Relationship
Phone #
Address
 

Reference #3

Full Name
Company
Relationship
Phone Number
Address
 

Previous Employment

Company 1
Phone Number
Address
Job Title
Supervisor
Starting Salary
Ending Salary
Responsibilities
Dates Employed
Reason for Leaving
May we contact your supervisor for a reference? Yes
No
 
Company 2
Phone Number
Address
Job Title
Supervisor
Starting Salary
Ending Salary
Responsibilities
Dates Employed
Reason for Leaving
May we contact your supervisor for a reference? Yes
No
 
Company 3
Phone Number
Address
Job Title
Supervisor
Responsibilities
Starting Salary
Ending Salary
Dates Employed
Reason for Leaving
May we contact your supervisor for a reference? Yes
No
 

Military Service

Branch
Dates Served
Rank at Discharge
Type of Discharge
If other than honorable, please explain
 
Did a current D&L employee refer you? If so, please enter their name.
Disclaimer * By submitting this application 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.
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