Untitled Document

Cooper Farms Employment Application/Pre-Employment Questionnaire

Print Application & Mail to:
COOPER FARMS, 185 County Road 1161, Fairfield, TX 75840 or fax to 903-389-5388

Personal Information

Employment Desired
(Circle one or more)

Roadside Sales
Out-of-Town (full-time)
In-Town (full-time)
In-Town (part-time)

Employment History: (List most recent first)

Address of Employer

Reason for leaving

Are there any events or activities you are involved in throughout the summer that might interfere with your work schedule or you would need to find a substitute for? If so, list all dates and activities below: BE VERY SPECIFIC
Attach sheet if necessary.

Is there anything else you want us to know about you? Attach extra sheet if necessary.

REFERENCES: (Please list at least 3 that are not related to you)

Business/Relationship:

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize
investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal
or otherwise, and release the company from any liability for any damage that may result from utilization of such information."

Personal Information
Name:	Date of Birth:
SS#:	Drivers License #:
Mailing Address:
Email Address:	Phone Number(s):
Have you ever had any traffic violations? Yes - No If so, please describe:
Have you ever been convicted of a crime? Yes - No If so, please describe:

Dates: (From-To)	Name of Employer	Address of Employer	Phone Number	Reason for leaving
_______ to present

Name:	Address:	Telephone Number:	Business/Relationship:

Employment Desired (Circle one or more)	Field Worker	Roadside Sales Out-of-Town (full-time) In-Town (full-time) In-Town (part-time)	Mail Order Packer
Employment History: (List most recent first)

Can you work Full or Part Time?	Can you work Sundays?
If you cannot work Sundays or if part-time, please explain how many days you are able to work.
Are there any events or activities you are involved in throughout the summer that might interfere with your work schedule or you would need to find a substitute for? If so, list all dates and activities below: BE VERY SPECIFIC Attach sheet if necessary.





Is there anything else you want us to know about you? Attach extra sheet if necessary.


REFERENCES: (Please list at least 3 that are not related to you)

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from any liability for any damage that may result from utilization of such information."
Date:	Signature of Applicant: