EMPLOYMENT

EMPLOYMENT APPLICATION

Employment with AgHeritage Farm Credit Services (AgHeritage) is considered "at will" - in other words, your employment is not governed by a written or oral contract. This means that your employment may be terminated at any time, with or without cause or notice, at your option or at the option of your employer. AgHeritage is an equal opportunity employer. Individuals are judged solely on the basis of their qualifications without regard to race, color, religion, sex (including pregnancy, sexual orientation, and gender identity), age, disability, genetic information, national origin, veteran status, or any other reason protected by law. We have a Standards of Conduct Policy. It is your obligation to review that policy and ensure that you are in compliance prior to your employment.

Today's Date

Personal Data

First Name

Middle Name

Last Name

Email Address

Permanent Address (Street/City/State/Zip Code)

County

(Area Code) Phone Number

Present Address (Street/City/State/Zip Code - if different from above)

(Area Code) Phone Number

Professional Society Memberships/Licenses

Omit those indicating religious, political, cultural, or social affiliations.

Are you legally authorized to work in the U.S. for any employer? In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the U.S. and to complete the required employment eligibility verification form upon hire.

Yes

Proof must be provided.

Have you been convicted of a felony?

Yes

If yes, please provide information regarding each felony conviction. For each conviction, please list the date of the conviction, the crime of which you were convicted, the sentence received, and the court of the conviction (a conviction will not automatically bar employment; all circumstances will be considered):

Position Desired

Desired Position or Type of Work

Date Available

Work Schedule of the position you are applying for

Full-time

Part-time

Summer

Temporary

Are you able to travel for business purposes?

Yes

If yes, please indicate the maximum percentage of annual travel is acceptable to you:

Will you relocate?

Yes

If yes, please list preferred locations:

Education

High School

School Address (City/State)

Graduated?

Yes

Major Coursework

Honors Received

Extra-Curricular Activities

College or Technical School

School Address (City/State)

Graduated?

Yes

Major Coursework

Minor Coursework

Degree/Certificates Granted or Units (Quarters/Semesters)

Honors Received

Extra-Curricular Activities

Post Graduate School

School Address (City/State)

Graduated?

Yes

Major Coursework

Minor Coursework

Degree/Certificates Granted or Units (Quarters/Semesters)

Honors Received

Extra-Curricular Activities

Other Education

School Address (City/State)

Graduated?

Yes

Major Coursework

Minor Coursework

Degree/Certificates Granted or Units (Quarters/Semesters)

Honors Received

Extra-Curricular Activities

Specialized Skills

Keying

Net WPM

Years of Exp.

Personal Computer

Equipment Operated

Years of Exp.

Personal Computer

Software Used

Years of Exp.

Other Skills and Years of Experience

Re-order	Skills	Years of Exp.	Weight	Operations
	Skills	Years of Exp.	Item weight

more items

Employment Record

Please list your employment history with your present or most recent employer first. Include all relevant financial, lending, or banking experience. In Section 6, please explain any periods of time not accounted for on your record of employment, including periods of military service or unemployment.

Have you ever been employed by a Farm Credit Institution?

Yes

where and dates?

First Employment Record

Employer (Current or Most Recent)

Mailing Address( City/State/Zip Code)

Job Title

Work Phone Number/Extension

Employed Start Date

Employed End Date

Work Schedule

Full-time

Part-time

Total Years on Job:

Reason for Leaving or Seeking Change

Supervisor's Name

May we contact this person

Yes

Phone Number:

Describe your responsibilities

Second Employment Record

Employer (Current or Most Recent)

Mailing Address( City/State/Zip Code)

Job Title

Employed Start Date

Employed End Date

Work Schedule

Full-time

Part-time

Total Years on Job:

Reason for Leaving or Seeking Change

Supervisor's Name

May we contact this person

Yes

Phone Number:

Describe your responsibilities

Third Employment Record

Employer (Current or Most Recent)

Mailing Address( City/State/Zip Code)

Job Title

Employed Start Date

Employed End Date

Work Schedule

Full-time

Part-time

Total Years on Job:

Reason for Leaving or Seeking Change

Supervisor's Name

May we contact this person?

Yes

Phone Number:

Describe your responsibilities

Fourth Employment Record

Employer (Current or Most Recent)

Mailing Address( City/State/Zip Code)

Job Title

Employed Start Date

Employed End Date

Work Schedule

Full-time

Part-time

Total Years on Job:

Reason for Leaving or Seeking Change

Supervisor's Name

May we contact this person

Yes

Phone Number:

Describe your responsibilities

SECTION 6: Other Experience/Comments

Certification

I authorize investigation of all statements in this employment application if I am considered for employment. The companies or people named herein are authorized to give information regarding me whether or not such information is part of their records, and they are released from all liability for issuing such information. I also understand that misrepresentation or omission of facts in this employment application will be sufficient cause for cancellation of consideration for employment or termination of employment.

Signature

Sign above

Date

I agree

Please mail or fax your completed application to: Human Resources Department, AgHeritage Farm Credit Services, 119 East 3rd Street, Suite 200, Little Rock, AR 72201, 501-613-0304 or you can e-mail it to: HRAgHeritage@agfcs.com.

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