• First Name

  *
• Last Name

  *
• Middle Initial

  *
• Address
• City

  *
• State

  *
• Zip Code
• Phone

  *
• Other Phone #

  *
• Email

  *

• Type of employment desired: (Please check all that apply).

  Full-Time Part-Time Educational Co-Op Seasonal Temporary

• Location you're applying for Select 1st choice & 2nd choice:

  Columbus Col Sales/Rental Jackson Janesville Ag
  Janesville CP Salem Prairie Du Sac Watertown
• Position (s) applying for:

  *
• How did you hear about Mid-State Equipment?

  *

• How Long Have you lived at your present Address?

  How Long Have you lived at your present Address

• What is the best time to call you on your cell phone or home?

  AM PM Cell Phone

• May we call you at work?

  AM PM Cell Phone

• Have you ever been employed at a Mid-Stated location before?

  Yes No

• Do you have any friends/relatives working here?

  Yes No

• Have you worked for other dealers

  Yes No

• Have you ever worked with farming/light industrial equipment?

  Yes No

• Do you have a Driver's License?

  Yes No
  

• Will you travel if the job requires it?

  Yes No

• Have you been convicted of a moving violation in the past 5 years?

  Yes No

• Are you legally eligible to work in this country?

  Yes No

  (proof will be required upon offer of employment)

The following question is not designated to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodations, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.

• Are you able to perform the essential functions of the job for which you are applying (with or without accommodations)?

  Yes No

• Date you are available to start working?

• What is you desired salary range or hourly rate of pay?

Answering "Yes" to the following question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness, and nature of the violation, rehabilitation and position applied for will be taken into account.

• Have you ever pled "guilty", "no contest" or been convicted of a crime?

  Yes No

Add More

• Office

  • Management Bookkeeping Accounts Receivable Accounts Payable
    Payroll Clerk Warranty Clerk Data Entry Cashier
    Advertising Promotions Receptionist Computer Microsoft Office
    Customer Service Record Keeping Typing Filing

• Parts

  • Parts Manager Parts Counter Parts Inventory Control Parts Stocker
    Parts Driver / Delivery

• Sales / Leasing

  • Management Farm Equipment Sales Person Turf Equipment Sales Person Light Industrial Equipment Sales
    F & I Management Leasing Management

• Service and Setup

  • Service Management Service Writing / Advisor Shop Foreman Tractor Mechanic
    Implement Mechanic Hydraulics Mechanic Small Engine Mechanic Machine Setup
    Diesel Mechanic Refrigeration Truck Driver Painting / Detailing
    Body Repair Welding

• Other

  • Janitorial Carpentry Building Maintenance

• Do you have any special licensing or certifications?

  
  

  Yes No

Previous salary will not be used to determine compensations with this employer

• • Employment From
  • Employment To

  • May we contact for a reference?

    
    

    Yes No Later
• • Employment From
  • Employment To

  • May we contact for a reference?

    
    

    Yes No Later
• • Employment From
  • Employment To

  • May we contact for a reference?

    
    

    Yes No Later
• • Employment From
  • Employment To

  • May we contact for a reference?

    
    

    Yes No Later
Add More

• If not addressed on previous page, have you ever been fired or asked to resign from a job?

  
  

  Yes No

Add More

Applicant's Statement

I certify that all information I provide in order to apply for and secure work with this employer is true and accurate, and without consequential omissions of any kind whatsoever. I understand that this application will be given every consideration, but is not a promise of employment.

I expressly authorize, without reservation, this employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), neighbors, friends, business associates, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. This inquiry includes information as to my character, education, work experience, 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 this investigation. I further authorize the company to contact my previous employers and I authorize those employers to disclose to the company all records pertinent to my employment to them. In addition to authorizing the release of any information regarding my employment, I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representative, and all other persons, corporations or organizations who release information to the company, and release them from any and all liability, claims, or damages that may directly or indirectly result from the use, disclosure, or release of any such information by any person or party, whether such information is favorable or unfavorable to me.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.

I understand that the company reserves the right to require me to submit to a test for the presence of drugs in my system prior to employment and at any time during my employment, to the extent permitted by law. I also understand that any offer of employment may be contingent upon the passing of a physical examination, and a test for the presence of alcohol or drugs in my system, performed by a doctor selected by the company. Further, I understand that at any time after I am hired, the company may require me to submit to a physical examination, and drug and alcohol testing, to the extent permitted by law. I consent to the disclosure of the results of they physical examinations and related tests to the company. I also understand that I may be required to take other tests, such as personality and honesty tests, prior to employment and during my employment.

If I am hired, I understand my employment will be for no definite period, regardless of the period of payment of my wages. I further understand that I have the right to terminate my employment at any time with or without cause and with or without prior notice, and the company reserves the same right to terminate my employment with or without cause or prior notice, except as may be required by law.

I also understand that, if I am hired, I will be required to provide proof of identity and legal authorization to work in the United State and that federal immigration laws require me to complete an I-9 Form in this regard.

DO NOT SIGN UNTIL YOU HAVE READ THE ENTIRE ABOVE STATEMENT

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