Kansas Ethanol
  An asterisk * indicates a required field.



  PERSONAL INFORMATION
Name
*Last
 *First 
 Middle 
Present Address
*Street 
 *City 
 *State      *Zip
     

*Telephone
 
Message phone
*Email Address

Position(s) applied for
1. 

2. 
How were you referred to Kansas Ethanol?
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Friend - Name
Walk-in
Other
GENERAL INFORMATION
*Date available to Work

Employment Desired Full-time    Part-time   Temporary     (check all of interest)
If you are under 18 years of age, can you provide required proof of your eligibility to work? Yes  No
Have you ever filled out an application with Kansas Ethanol before?
If yes, please give date: 		Yes  No
Are you currently employed? Yes  No
May we contact your present employer for references? Yes  No
For purposes of compliance with the Immigration Reform and Control Act, are you legally eligible to work in the United States?
Under the Immigration Reform and Control Act of 1986, should you be employed you will be required to fill out a certification verifying that you are eligible to be employed and verifying your identity and provide documentation to that effect.
 Yes  No
Have you ever been convicted of a crime?
If yes, explain number of convictions, nature of offense(s) leading to convictions(s), how recently such offense(s) was/were committed, sentences(s) imposed, and type(s) of rehabilitation.
 Yes  No
  WORK HISTORY
Starting with your present or most recent job, describe all paid, military and applicable voluntary experience. Highlight your knowledge, skills and abilities which best demonstrate your qualifications for this position.
Employer
 Address
 Telephone Number(s)
Supervisor


Job Title
 Employment dates
  from 

      to  		Base pay   
  start 

  final 

Reason for leaving
 Work Performed: List any jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Employer
 Address
 Telephone Number(s)   
Supervisor


Job Title
 Employment dates
  from 

      to  		Base pay   
  start 

  final 

Reason for leaving
 Work Performed: List any jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Employer
 Address
 Telephone Number(s)   
Supervisor


Job Title
 Employment dates
  from 

      to  		Base pay   
  start 

  final 

Reason for leaving
 Work Performed: List any jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
  EDUCATION
High School:
*Years completed (check highest level completed) Less than 9 9 10 11 12
Name of School
 Location (mailing address)
   Diploma/Degree
Yes No
Technical School or Junior College:
Years completed (check highest level completed) None 1 2
Name of School
 Location (mailing address)
   Diploma/Degree
Yes No
College:
Years completed (check highest level completed) None 1 2 3 4
Name of School
 Location (mailing address)
   Diploma/Degree
Yes No
Other:
Years completed (check highest level completed) None 1 2 3 4
Name of School
 Location (mailing address)
Diploma/Degree
Yes No
  U.S. Military Service
Have you ever had any job-related training in the United Sates military? Yes No

If yes, please describe training/ experience received:


Summarize special skills and training not listed above:


Describe honors received:


List professional, trade, business, or civil activities and offices held. Please indicate any prior military service that you would like considered in connection with your application for employment. You may exclude memberships that may reveal sex, race, religion, national origin, age, or disability or other protected status.
  References
Name Business Telephone Occupation
*1. *1. *1.
*2. *2. *2.
*3. *3. *3.
  Special Skills and Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience.
  Notification and Agreement
Please read before signing.

I certify that the answers given herein are true, accurate and complete to the best of my knowledge. . I understand that the falsification, misrepresentation or omission of fact on this application (or any other accompanying or required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.

Questions regarding this statement should be directed to the Office Manager before signing. The application will be given every consideration, but its receipt does not imply that the applicant will be employed.

It is the policy of KANSAS ETHANOL to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, national origin, marital status, or pregnancy, and to afford equal opportunities to disabled veterans, veterans of the Vietnam era, and individuals with a disability, and any other characteristic protected by Federal, State or Local law.

By signing below, I authorize you to communicate with persons listed as references, former employers, and any others with whom you desire to check as may be necessary in arriving at an employment decision. I release from all liability anyone supplying such information and I also release the employer from all liability that might result from making an investigation.

If hired, I agree to abide by all of KANSAS ETHANOL’S rules and regulation, and understand that, if employed, my employment may be terminated with or without cause, and with or without notice, at any time, at the option of either KANSAS ETHANOL or myself. I further understand that no representation, whether oral or written by any representative or agent of KANSAS ETHANOL, at any time, can constitute a contract of employment. I understand that KANSAS ETHANOL shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures, benefits or other terms or conditions of employment. No representative or agent of KANSAS ETHANOL has the authority to enter into any agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other term or condition of employment other than in a document signed by the General Manager, or to make any agreement contrary to the foregoing.

I understand that if offered a position with KANSAS ETHANOL, I may be required to submit to a pre-employment drug screening and background check as a condition of employment. I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these pre-employments tests and checks will result in withdrawal of any employment offer or termination of employment if already employed.

I understand this application will be considered current for a period of 90 days; after that time, if I wish to be considered for employment, I must submit a new application.

I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me.

* Applicant Signature:    *Date:



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