How were you referred to Centrum Valley Farms?
* -- No answer -- Company Employee Online Job Board Job/Career Fair Recruiting Agency Other
Who referred you to this position? Enter their first and last name here
Opportunity you are applying for:
* -- No answer -- Electrician Flock Specialist/Especialista de Aves Processing Supervisor in Training HVAC Technician Layer Sanitation Specialist/Especialista de Saneamiento Loader/Cargador Machine Operator/Operador de Maquina Maintenance Technician Night Operations Specialist/Especialista de Operaciones Nocturnas Packer/Empaque Palletizer/Paletero Pest Prevention Technician Quality Assurance Technician Safety Coordinator
Are you seeking full time or part time?
* Full Time Part Time (Weekends)
When can you start with the Centrum Valley Farms team?
Are you 18 years of age or older?
* -- No answer -- Yes No
Which of our VERSOVA sister companies are you wanting to join?
* Centrum Valley Farms (Clarion, IA) Iowa Cage Free (Goldfield, IA) Hawkeye (Corwith, IA)
Have you ever applied here before? If so, when?
Have you been employed by any of our VERSOVA sister companies before? If so, when?
Have you ever been convicted of any law violation? Include any plea of “guilty” or “no contest.” Exclude minor traffic violations.) If yes, provide details at your own discretion: A conviction will not necessarily disqualify an applicant for employment.
If employed, do you expect to be engaged in any additional business or employment outside of our job? If yes, provide details:
For Driving Jobs Only: Do you have a valid driver’s license?
-- No answer -- Yes No
Driver’s License Number, Class of license, State Licensed In:
Have you had your driver’s license suspended or revoked in the last 3 years?
List professional, trade, business or civic activities and offices held. (Exclude labor organizations and memberships which reveal race, color, religion, national origin, sex, age, disability or other protected status.)
Your highest level of education you have:
What skills or additional training do you have that relate to the job for which you are applying?
What machines or equipment can you operate that relate to the job for which you are applying?
List names of employers from the most recent to the oldest job you have had. Account for all periods of time including military service and any periods of unemployment. if self-employed, give firm name and supply business references. Note: A job offer may be contingent upon acceptable references from current and former employers:
1. Name of the company
2. Name and phone number of your supervisor
3. Month and year you started working there
4. Month and year you stopped working there
5. Your job title
6. Reason for leaving
Are you presently employed? If so, how many weeks in advance do you need to join our team?
Have you ever been fired from a job or asked to resign? If yes, please explain:
Give three references, not relatives or former employers:
3) PHONE NUMBER
I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.
I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.
I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment, if required.
I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying.
I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BY MANAGEMENT, OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. ONLY THE PRESIDENT OF THE ORGANIZATION HAS THE AUTHORITY TO ENTER INTO AN AGREEMENT OF EMPLOYMENT FOR ANY SPECIFIED PERIOD AND SUCH AGREEMENT MUST BE IN WRITING, SIGNED BY THE PRESIDENT AND THE EMPLOYEE. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT REASON AND WITH OR WITHOUT NOTICE.
This application for employment will remain active. Ask the organization’s representative for details
I have read, understand, and by my signature consent to these statements. *
Centrum Valley Farms is an Equal Opportunity Employer and is dedicated to a policy of non-discrimination in employment on any basis including: age, sex, color, race, national origin, religion, marital status, political belief, or disability. This application will be given every consideration, but is not a guarantee of employment.
I certify that my answers to the above questions are true and correct without any consequential omissions of any kind. I understand that if I am employed, any false, misleading, or otherwise incorrect statements made on this application form or during any interviews may be grounds for my immediate discharge.
By writing my name below, I am stating that I understand and accept the terms as stated above. *
The following questions are entirely optional.
To comply with government Equal Employment Opportunity / Affirmative Action reporting regulations, we are requesting (but NOT requiring) that you enter this personal data. This information will not be used in connection with any employment decisions, and will be used solely as permitted by state and federal law. Your voluntary cooperation would be appreciated.
Decline to answer Female Male
Decline to answer Hispanic or Latino White, not Hispanic or Latino Black or African-American, not Hispanic or Latino Asian, not Hispanic or Latino Native Hawaiian or Other Pacific Islander, not Hispanic or Latino American Indian or Alaskan Native, not Hispanic or Latino Two or More Races, not Hispanic or Latino
Invitation for Job Applicants to Self-Identify as a U.S. Veteran
A “disabled veteran” is one of the following:
a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or
a person who was discharged or released from active duty because of a service-connected disability.
A “recently separated veteran” means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
An “Armed forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
Voluntary Self-Identification of Disability
Voluntary Self-Identification of Disability Form CC-305
OMB Control Number 1250-0005
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if
you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.
If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.
Disabilities include, but are not limited to:
Multiple sclerosis (MS)
Missing limbs or partially missing limbs
Post-traumatic stress disorder (PTSD)
Obsessive compulsive disorder
Impairments requiring the use of a wheelchair
Intellectual disability (previously called mental retardation)
Please check one of the boxes below:
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures,
providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at
PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.