Application

Premium Iowa Pork

APPLICATION FOR EMPLOYMENT

PREMIUM IOWA PORK, L.L.C. 108 First Ave. South, Hospers, IA 51238
Mailing Address: P.O. Box 188 Hospers, IA 51238 Phone: 712-752-8666 Fax: 712-752-8169



PERSONAL INFORMATION


Name


Address





JOB PLACEMENT QUESTIONS

THE FOLLOWING INFORMATION IS REQUIRED FOR A BONA FIDE OCCUPATIONAL QUALIFICATION.



**You will not be denied employment solely because of a conviction record, unless the offense is related to the job for which you have applied.

PREFERRED POSITION AND SHIFT




EDUCATION


GRAMMAR SCHOOL
HIGH SCHOOL
COLLEGE/ TRADE, BUSINESS, CORRESPONDENCE SCHOOL
*The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age.

GENERAL

SPECIAL KNOWLEDGE OR SKILLS: (Knife Experience, Computer, Licenses, Certifications and etc.)

EMPLOYER 1
EMPLOYER 2
EMPLOYER 3

REFERENCES

(GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR).

PERSON 1
PERSON 2
PERSON 3

PHYSICAL RECORD




IN CASE OF EMERGENCY NOTIFY:

*I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND I UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL. I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE PERSONAL OR OTHERWISE, AND RELEASE ALL PARTIES FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING SAME TO YOU. I UNDERSTAND AND AGREE THAT IF HIRED, MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT ANY PRIOR NOTICE.*




Premium Iowa Pork, LLC is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, PIP invites employees to voluntarily self-identify their race or ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.


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