*First Name:

*Last Name:

Middle Initial:

*Street Address:

*City:

*State:

*Zip:

*Telephone

Email:

*Type of work for which you wish to be considered:

Employment History

Please list your complete employment history. List present or most recent employer first. Attach document with additional employers.

1.

Employer:

Dates employed (Month/Year):

Present or last salary:

Type of work performed:

Reason for leaving:

2.

Employer:

Dates employed (Month/Year):

Present or last salary:

Type of work performed:

Reason for leaving:

Attach list of additional employers:

Please select a file

Please do not upload files containing personal identifiable information (PII). This includes but is not limited to SSN, credit card number, driver's license number, or taxpayer ID.

Education

1. High School

Name/Location:

Last Year Completed:

2. College

Name/Location:

Last Year Completed:

Major Courses:

Diploma/Degree:

3. Business or Trade

Name/Location:

Months attended:

Major Courses:

Diploma/Degree:

Armed Forces

If you served in the United States Armed Forces, briefly describe the skills you acquired:

Personal Information

Are you legally authorized to work in the U.S.?

Yes No

Note: you will be required to furnish documents to verify your eligibility for employment in accordance with the Immigration Reform and Control Act and your employment is contingent upon furnishing such documents.

Are you at least 18 years of age?

Yes No

Have you ever been convicted of a crime or are there any pending charges against you?

Yes No

(A conviction does not automatically bar you from employment)

If yes, include details:

Are you presently employed?

Yes No

If so, may we contact your present employer:

Yes No

If hired, when would you be available?

What are your salary requirements?

References

Name:

Occupation:

Address:

City, State, Zip:

Telephone Number:

Attach list of additional references:

Please select a file

Please do not upload files containing personal identifiable information (PII). This includes but is not limited to SSN, credit card number, driver's license number, or taxpayer ID.

I certify that the answers given by me to the foregoing questions and statements are true and correct to the best of my knowledge without consequential omissions of any kind. I agree that the Company shall not be held liable in any respect if my employment is rejected or subsequently terminated because of false statements, answers or omissions made by me in this application. I understand that any misleading or incorrect statements may render this application void, and if employed, may lead to employment termination. I understand that a medical examination based on the requirements of the position for which I am being considered may be required, and drug testing may be included as part of the regular pre-employment physical. I also voluntarily and knowingly authorize the companies, schools or persons named above to give any information requested regarding my former employment, character and qualifications. I hereby voluntarily and knowingly fully release and discharge, absolve, indemnify, and hold harmless said companies, schools or persons from any and all liability for any damages for issuing this information, except for the malicious and willful disclosure of derogatory facts concerning my employment made for the express purpose of preventing me from obtaining employment, which the party disclosing such facts knows to be untrue. In consideration of my employment, I agree to conform to the rules and regulations of this organization. My employment and compensation can be terminated with or without cause and with or without notice, at any time, at the option of either my employer or myself.

Check box to certify.

Yes

*Security Code

Employment Application

Application for Employment

Linn Cooperative Oil Co

Employment History

1.

2.

Education

1. High School

2. College

3. Business or Trade

Armed Forces

Personal Information

References