Employment Application Form - Tri-County Co-op

General Information

First Name:

M.I.

Last Name:

Social Security No.

Email:

Phone:

ID #

Date:

Current Address

City:

State:

Zip:

Note: If not a resident at current address for 2 years, give previous address & phone number:

Lived there From:

To:

Phone:

Previous Address

City:

State:

Zip:

Have you ever been convicted of a felony?

YES NO

Note: Do not answer "YES" if your official conviction record has been annulled, expunged or sealed. A past criminal history does not necessarily disqualify an applicant from employment.

If YES, please describe fully:

Do you have any relatives or friends working for this Company?

YES NO

If "YES" give name:

Have you ever worked for this Company before?

YES NO

If "YES", when and what Department?

Incase of Emergency , who should we notify?

Name:

Address:

Phone:

Job Interest

Position applying for:

Referred by:

Type of employment desired:

Full-Time Part-Time Seasonal

Shift Preference:

Salary Required:

Are you willing to work overtime?

YES NO

Are you willing to work weekends?

YES NO

Are you willing to work at different locations?

YES NO

Date available to start:

Are you over 18 years old?

YES NO

Are you over 21 years old?

YES NO

Education

High School Name:

Address:

From:

To:

Diploma

YES NO

College Name:

Address:

From:

To:

Degree

University Name:

Address:

From:

To:

Degree

References

Please list two people who know of your qualifications and work abilities (do not include relatives)

Name:

Address:

Telephone:

Name:

Address:

Telephone:

Employment History

Employer Name:

Address:

From

Job Title:

Phone #:

Salary:

Reason for leaving:

Employer Name:

Address:

From

Job Title:

Phone #:

Salary:

Reason for leaving:

Employer Name:

Address:

From

Job Title:

Phone #:

Salary:

Reason for leaving:

SPECIAL SKILLS & QUALIFICATIONS

RELEASE AND CONSENT

I understand and certify that all information supplied in this application, and attached resume, is complete and correct. Any false, misleading, or incomplete information furnished by me regarding this application may result in the rejection of this application or, if employed, dismissal.

I understand that in consideration of my employment, I agree to conform to the rules and regulations of the employer, and further agree that my employment and compensation are at the will of the employer and can be terminated, with or without cause, and with or without notice, at any time at the option of either the employer or myself.

I authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information they may have, personal or otherwise, with regard to any of the subjects covered by this application, and I release such parties from all liability from any damages which may result from furnishing such information to you.

I certify that the above answers are true and complete to the best of my knowledge. I authorize Tri-County Coop to investigate any statement contained in this application, and to determine my qualifications. I understand that this application is not intended to be any kind of contract or agreement. I understand that I am required to abide by all rules and regulations.

Signed:

Date:

Tri-County Co-op

General Information

Job Interest

Education

References

Employment History

SPECIAL SKILLS & QUALIFICATIONS

RELEASE AND CONSENT

Get in touch

Call us

Our Location

Send us a message. We'll reach out

Tri-County Co-op

40% more efficient

Restores up to 4.5% more power

Restores up to 5% better fuel economy

2.5x more effective

Months longer

Up to 75% reduced filter blocking²

Renewable fuels: ethanol blends

Formulated for vehicles, new and old

Highly recommended

Restores engine power

Standard in every grade

Certified

2.5x cleaning power

General Information

Job Interest

Education

References

Employment History

SPECIAL SKILLS & QUALIFICATIONS

RELEASE AND CONSENT

Get in touch

Call us

Our Location

Send us a message. We'll reach out

Tri-County Co-op

The next generation of Cenex® premium diesel fuels

40% more efficient

Restores up to 4.5% more power

Restores up to 5% better fuel economy

2.5x more effective

Months longer

Up to 75% reduced filter blocking2

Cenex® TOP TIER™ Renewable Fuels

Renewable fuels: ethanol blends

Propane

A clean, efficient energy solution

🔥 Save More with Propane from Tri County Co-op!

Clean • Efficient • Delivered in Bulk

✅ Ready to Make the Switch or Refill?

Lubricants

Cenex® TOP TIER™ detergent gasoline

Formulated for vehicles, new and old

Highly recommended

Restores engine power

Standard in every grade

Certified

2.5x cleaning power

Heading

Up to 75% reduced filter blocking²