Application for Employment

At Valley United Co-op we do not discriminate in employment based on any protected class
contained in the applicable federal, state and local laws. VUC complies with applicable state and local
laws governing nondiscrimination in employment in every location in which the company has facilities.

*First Name:

*Middle Initial:

*Last Name:

*Toady's Date:

*Phone No.:

*Address:

Address #2:

*City:

*State:

*Zip:

*Emergency Contact Name:

*Emergency Contact Phone No.:

*Are You A Citizen Of The USA Or Do You Have The Legal Right To Work In The US?:

Yes
No

*Employment Desired:

*Salary Desired:

*Are You Employed Now:

*Location Desired:

Describe any specialized training, apprenticeship, certifications, office skills or programs, trucking, transportation or other experience that may help in your work for this company. :

Employer (Start With Most Recent):

Dates of employment: From- Month, Year - To: Month, Year:

Position Held:

Address, City, State, Zip:

Contact Name, Phone Number:

Employer (2nd to Recent):

Dates of employment: From- Month, Year - To: Month, Year:

Position Held:

Address, City, State, Zip:

Contact Name, Phone Number:

Employer (3ed to Recent):

Dates of employment: From- Month, Year - To: Month, Year:

Position Held:

Address, City, State, Zip:

Contact Name, Phone Number:

Reference 1:

Name, City & State, Relationship, Phone Number

Reference 2:

Name, City & State, Relationship, Phone Number

Resume Upload:

Security code: