Blanchardville Coop Employment Application

314 S Main St, Blanchardville, WI 53516 - Phone: 608 - 523 - 4293

Qualified applicants are consider for all positions without regard to race, color, religion,
gender, national origin, age, marital or veteran status, or any legally protected status.

At Blanchardville Coop, we seek friendly and energetic people who are committed to providing outstanding service while making lasting impressions on our customers. You will need to have great communication skills, teamwork and excel at customer service! Our goal is to offer a positive and fun atmosphere for all of our employees and customers to enjoy

As a employee of Blanchardville Coop, you can expect several things from us:

  • A fair and respectful work place
  • A chance to be part of a winning team that makes a difference every day
  • Training and support to do your job successfully

We also have expectations of you during your time at Blanchardville Coop. Our ideal employees are:

  • Friendly! They enjoy meeting customers, and giving exceptional service every visit.
  • Dependable. They arrive on time for all shifts.
  • A Team player. Teamwork is a key to the successful operation of our company.
  • Sincere - in making the customer and other co-workers feel important and respected.

Job you are applying for:
     Store or Location:
    
How did you learn about us?
Advertisement Relative Inquiry Employment Agency Friend
Other
First Name: Middle Initial: Last Name:
Address: City: State: Zip:
Telephone Number: Alternative Telephone Number:
Email Address:
Availability

Are you available to work:

  • Full-Time
  • Part-Time
  • Temporary
  • Any
Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Best time to contact you at home is................... E.G. 6:00pm
If you are under 18 years of age, can you provide required proof of your eligibility to work?....... Yes No
Have you ever filed an application with us before?........... Yes No -- If Yes, give date: E.G 2/28/2010
Have you ever been employed with us before?................. Yes No -- If yes, give date: E.G 2/28/2010
Do any of your friends or relatives, other than spouse, work here?.... Yes No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Yes No
Proof of citizenship or immigration status will be required upon employment.

Date available for work: What is your desired rate of pay?

Hours per week preferred:
Have you ever been convicted or pled guilty to any crime involving violence to another person?......... Yes No
Have you ever been convicted or pled guilty to any crime involving retail theft, fraud, or embezzlement?......... Yes No
Have you ever been convicted or pled guilty to any crime involving distribution of drugs or controlled substances?......... Yes No
Education
  Name of School Address Did you
Graduate?		 Major/Degree
High School
College
Are you applying as a Commercial Driver?
LICENSE INFORMATION
No person who operates a commercial motor vehicle shall at any time have more than one driver’s license (49 CFR 383.21). I certify that I do not have more than one motor vehicle license, the information for which is listed below. Include 3 most recent licenses and dates.
STATE LICENSE # TYPE/CLASS ENDORSEMENTS EXPIRATION DATE
PREVOIUSLY HELD LICENSES
DRIVING EXPERIENCE
CLASS OF EQUIPMENT TYPE OF EQUIPMENT (VAN, TANK, FLAT, ETC.) DATE FROM DATE TO APPROX # OF MILES (TOTAL)
STRAIGHT TRUCK
TRACTOR & SEMI-TRAILER
TRACTOR & 2 TRAILERS
TRACTOR & TANKER
OTHER
ACCIDENT RECORD for PAST 3 YEARS
DATES (List most recent first) NATURE OF ACCIDENT (Head-on, rear-end, upset, etc.) # FATALITIES # INJURIES CHEMICAL SPILLS (Y/N)
TRAFFIC CONVICTIONS and FORFEITURES for PAST 3 YEARS (DO NO INCLUDE PARKING VIOLATIONS)
DATE CONVICTED (Month/Year) VIOLATION STATE OF VIOLATION PENALTY (Forfeited bond, collateral and/or points)
Have you ever been denied a license, permit, or privilege to operate a motor vehicle? Yes No
Has any license, permit, or privilege ever been suspended or revoked? Yes No
Employment Experience
Please list your work experience for the past five years, beginning with your most recent job held. If you were self-employed give firm name.

Job 1

Work Performed

Job 2

Work Performed

Job 3

Work Performed
Other Qualifications

Summarize special job-related skills and qualifications acquired from employment or other experience.
References Not including former employers or relatives.

Reference 1

Reference 2

Reference 3

IMPORTANT – READ BEFORE SIGNING

In exchange for the consideration of my job application by Blanchardville Coop (hereinafter called “the Company”), I agree that: Both the undersigned and the Company may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others and hereby release the Company from any liability as a result of such contact.

I also understand that the Company has a drug and alcohol policy and consent to and compliance with such policy is a condition of my employment.

I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.

I further understand that my employment with the Company shall be probationary for a period of sixty (60) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.

Todays date:

I, acknowledge that I have read and understand the applicant statement.