Harvest Equipment Operator

Employee Information

First Name*

Middle Initial*

Last Name*

Address*

How long have you lived there?*

Date of Birth*

Social Security Number

Email*

Phone Number

Preferred Contact Method*

Do you have a social security number?*

Citizenship/Work Status*

U.S. Citizen Green Card Holder U.S. Work Permit/Visa H2A Worker

Marital Status*

Single Married

Are you a smoker?*

Do you suffer from Allergies?*

Do you speak fluent English?*

Have you ever been convicted of a crime in the United States?*

When are you available to start?*

How did you hear about us?*

Facebook Google Current Employee Former Employee

Experience And Qualifications

Driver's License

State Issued

License #

Type/Class

Expiration Date

Do you have a CDL?*

CDL Number

Driving Experience

Select From The Following*

If (other), please Specify

Type of Equipment*

Van Tank Flats Other

Date (From)*

Date (To)*

Approximate Number of Miles*

General Experience

Check All That Apply*

Truck Driving Experience Welding Experience Farm Equipment Operation (Combines)

Please Describe Any Background Experience*

Employment Record

Last Employer

Employer Name*

Employer Address*

Employer Phone Number*

Position Held*

Employment Date (From)*

Employment Date (To)*

Reason for leaving*

References:

Reference Names*

Reference Phone Numbers*

Emergency Contact

Name/Relationship*

Emergency Contact Address*

Emergency Contact Phone Number*