KANSAS ETHANOL LLC


	Kansas Ethanol, LLC Employment Application

Paper Application Form

First Name

Last Name

Middle Initial

Address

City

State

Zip

Telephone Number

Message Phone

Email Address

Position(s) Applied For

How were you referred to Kansas Ethanol? Advertisement Friend Walk-in Other

If referred by friend, please provide their name.

Date available for work

Availability		Full-time Part-time Temporary

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? Yes No

If yes, please give date:

Have you ever been employed with Kansas Ethanol before? Yes No

If yes, please give date:

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? Yes No

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.

Have you ever been convicted of a crime? Yes No

If yes, explain number of convictions, nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.

Employer

Date employed from:

Date employed to:

Starting Base Pay

Final Base Pay

Address

Telephone Number(s)

Job Title

Supervisor

Reason for Leaving

Work Performed (List the jobs you held, duties performed, skills used, advancements or promotions while you worked at this Company.)

Employer

Date employed from:

Date employed to:

Starting Base Pay

Final Base Pay

Address

Telephone Number(s)

Job Title

Supervisor

Reason for Leaving

Work Performed (List the jobs you held, duties performed, skills used, advancements or promotions while you worked at this Company.)

Employer

Date employed from:

Date employed to:

Starting Base Pay

Final Base Pay

Address

Telephone Number(s)

Job Title

Supervisor

Reason for Leaving

Work Performed (List the jobs you held, duties performed, skills used, advancements or promotions while you worked at this Company.)

Employer

Date employed from:

Date employed to:

Starting Base Pay

Final Base Pay

Address

Telephone Number(s)

Job Title

Supervisor

Reason for Leaving

Work Performed (List the jobs you held, duties performed, skills used, advancements or promotions while you worked at this Company.)

High School Name

High School Address

Years Completed (select highest level completed) 9 10 11 12

Diploma / Degree		Yes No

Technical School or Junior College Name

Technical School or Junior College Address

Years Completed (select highest level completed) 1 2

Diploma / Degree		Yes No

Major Course(s) of Study

College Name

College Address

Years Completed (select highest level completed) 1 2 3 4

Diploma / Degree		Yes No

Major Course(s) of Study

Other Education Name

Other Education Address

Years Completed (select highest level completed) 1 2 3 4

Diploma / Degree		Yes No

Major Course(s) of Study

Have you ever had any job-related training in the United States 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, r

You may exclude memberships that may reveal sex, race, religion, national origin, age, or disability or other protected status.

Reference #1 Name

Reference #1 Business Telephone

Reference #1 Occupation

Reference #2 Name

Reference #2 Business Telephone

Reference #2 Occupation

Reference #3 Name

Reference #3 Business Telephone

Reference #3 Occupation

Summarize special job-related skills and qualifications acquired from employment or other experience.

Please type the text in the box.

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.