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Briggs & Sons Employment Application
First Name*
Middle Name
Last Name*
Street Address
City
State:
Zip Code:
Best Phone Number*
2nd Phone Number
E-Mail Address*
Date of Birth*
 
Shirt Size
Coat Size
Education Level
Marital Status:
Starting Date
 
Ending Date
 
Emergency Contact*
Emergency Contact Phone*
Emergency Contact Relationship*
Physician Information
Physician Name
Physician`s Complete Address
Physician
Personal Information
(Please answer yes or no, if yes please explain)
Do you wear corrective lenses?
Any impairments/dietary needs which require special attention?
Are you on any medications?
Do you Smoke?
Explain any Yes
Driver Information
(If possible, please include a photo copy of your drivers license with this application)
Drives License Number*
State Issued*
License Type*
Expiration Date*
 
Photo of License Upload
 
Restrictions
DOT Health Card
Violations in past 5 years
Outstanding Tickets
DUI*
Arrests/convictions*
Any comments
Preferred Position
Experience
Type of truck(s) operated
Transmissions
Combine(s) operated
Other ag equip experience
Other related skills
Previous Employment
(If you don`t have employers please list 3 character references)
Employers Name/Supervisor
Address/Phone Number
Start Date
 
End Date
 
Duties Performed
Employers Name/Supervisor
Address/Phone Number
Start Date
 
End Date
 
Duties Performed
Employers Name/Supervisor
Address/Phone Number
Start Date
 
End Date
 
Duties Performed
NOTE: All information on this application will be kept confidential.
I give you permission to further research the information contained on ths application and understand that misinformation or false statements listed above could result in my dismissal.
Signature-Type Full Name*
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