Careers Blains Farm Fleet Form – Fill Out and Use This PDF

Thank you for considering a career with Blain’s Farm & FleetTM. Now that you have downloaded our employment application, here’s what you need to do.

1.Print out this application.

2.Fill out the application completely.

3.Take it to the customer service desk at your local Blain’s Farm & Fleet retail store. You can drop off your application any time during normal business hours:

Monday through Friday: 8:30am - 9:00pm

Saturday: 8:30am - 8:00pm

Sunday: 9:00am - 6:00pm

An equal opportunity,

tobacco & drug free employer.

Please note that positions were open at the time that they were posted to our web site.

EMPLOYMENT HISTORY (Starting with your present or last job, list all previous employers, and include military service.)

Current or Most Recent Employer		Employment Dates
Employer Name		From:	To:
Address		Hours Worked Per Week:
Telephone Number	Supervisor’s Name &Title	Starting Wage:	Per: Hour
		Final Wage:	Year
Job Title(s), Duties, and Responsibilities

Previous Employer		Employment Dates
Employer Name		From:		To:
Address		Hours Worked Per Week:
Telephone Number	Supervisor’s Name &Title	Starting Wage:			Per:	Hour
		Final Wage:				Year
Job Title(s), Duties, and Responsibilities
Reason for Leaving		Office Use Only
		Information Verified:	Yes	No	Initials
Previous Employer		Employment Dates
Employer Name		From:		To:
Address		Hours Worked Per Week:
Telephone Number	Supervisor’s Name & Title	Starting Wage:			Per:	Hour
		Final Wage:				Year
Job Title(s), Duties, and Responsibilities
Reason for Leaving		Office Use Only
		Information Verified:	Yes	No	Initials

If you require additional space, please contact a company representative for an Employment History Continuation Sheet.

Please account for any gaps in employment of thirty (30) days or more. This includes self-employment. Please explain with pertinent dates.

_______________________________________________________________________________________________________________

I certify that the information on this application is true and correct. I understand that any omission or misrepresentation is grounds to deny employment or end the employment relationship. I understand that a consumer report may be requested and may include information as to my character, work habits, credit, academic-credential verification, job performance, experience and reasons for termination. I further understand that Farm and Fleet may request information concerning my motor vehicle operations history, criminal and civil history, in addition to other public records available from various private and public sources. I hereby authorize and release from all liability, without reservation, this Company and any law enforcement agency, administrator, State/Federal agency, institution, information service bureau, employer, employee, company or person gathering or furnishing the above-mentioned information. Any misrepresentation or false statement found during such examination may be sufficient cause to deny employment or end the employment relationship. In consideration of my employment, I agree to conform to the rules and regulations of the Company and understand that my employment can be terminated with or without notice, at any time, at the option of either the Company or myself. This company reserves the right to conduct pre-employment and employment drug testing and I agree to submit to such tests. I understand that this application will remain active for 30 days from today’s date. If I still desire a position with the Company after this application expires, it will be my responsibility to complete a new application.

Date Submitted :_____________________

Signature: ___________________________________________________________

Rev 11/08