Valdosta Application

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Garner, NC | Greenville, NC | Lumberton, NC | Florence, SC | Statesboro, GA | Tifton, GA | Valdosta, GA | Petersburg, VA | Micro, NC | Manager/Corporate

Apply for a Position in Valdosta, GA | Agri Supply Company/Direct Distributors, Inc.

An Equal Opportunity Employer

This Company does not discriminate in hiring or employment on the basis of race, color, sex, religion or national origin nor on the basis of age with respect to persons 18 years or older. No question on this application is intended to secure information to be used for such discrimination. Proof of identity and work authorization will be required upon employment in accordance with federal regulations. We advise that we intend to check and hold you responsible for the accuracy of the Statements you make on this application. This application will receive consideration for thirty (30) days. If you have not heard from the company within thirty days and wish to receive further consideration for employment, it will be necessary to complete another application form.

Applicant Personal Information: Note: We don't ask for your SSN online. If you are contacted for an interview, you will be expected to provide it then, thank you.
Name:  
  First Middle Last  
Address:  
  Street Address  
   
  City State Zipcode  
Phone: Age 18 or older?  
  Area Code + Phone Number   Yes or No  
Are you a U.S. Citizen? If you are not you a U.S. Citizen, can you legally work in the U.S.?  
  Yes or No   Yes or No  
  Have you been convicted of a felony other than minor traffic violations? (A "yes" answer to this question does not necessarily preclude consideration for employment)  
    Yes or No  
Position Applying For: Note: If there are no positions available in the dropdown, you may submit your application for general review, thank you.
Position:  
Employment Information:
Salary Desired: Are you employed now? If so, may we contact your present employer?  
      Yes or No   Yes or No  
  Have you ever applied here before? Have you ever worked for this company or one of our related companies?  
    Yes or No   Yes or No  
  If you answered yes to either of the above, please tell us when and where?
  
  Is there any circumstance that you know of that would prevent you from working standard operating hours? (varies per location: 7am - 7pm, Monday - Saturday)
  
Referred By: Date you can report to work?  
Work History: All information must be completed in its entirety for consideration. List your last 4 employers, starting with the most recent, thank you.
Employer 1: Period of Employment:  
      From mo/yr To mo/yr  
Address:  
  Street Address  
   
  City State Zipcode  
Phone: Supervisor:  
  Area Code + Phone Number      
Starting Pay: Ending Pay:  
  Positions Held, Duties:
  
  Reason For Leaving:
  
Employer 2: Period of Employment:  
      From mo/yr To mo/yr  
Address:  
  Street Address  
   
  City State Zipcode  
Phone: Supervisor:  
  Area Code + Phone Number      
Starting Pay: Ending Pay:  
  Positions Held, Duties:
  
  Reason For Leaving:
  
Employer 3: Period of Employment:  
      From mo/yr To mo/yr  
Address:  
  Street Address  
   
  City State Zipcode  
Phone: Supervisor:  
  Area Code + Phone Number      
Starting Pay: Ending Pay:  
  Positions Held, Duties:
  
  Reason For Leaving:
  
Employer 4: Period of Employment:  
      From mo/yr To mo/yr  
Address:  
  Street Address  
   
  City State Zipcode  
Phone: Supervisor:  
  Area Code + Phone Number      
Starting Pay: Ending Pay:  
  Positions Held, Duties:
  
  Reason For Leaving:
  
  Please list job related skills which you possess that would be beneficial for this job:
  
  Please list any knowledge, special technical or computer skills, and/or qualifications that you have acquired from employment or other experience:
  
Educational Background:
  Select the highest level in a grade, junior or high school, or in a college or technical school which you have achieved.

  
  GRADE, JUNIOR, HIGH SCHOOL
1 2 3 4 5 6 7 8 9 10 11 12 		 
  or COLLEGE, TECH
  
  NAME OF SCHOOL LOCATION MAJOR STUDIES DID YOU GRADUATE?  
HlGH SCHOOL  
TECH or TRADE  
COLLEGE  
GRADUATE  
OTHER  
  LIST DEGREES AND SPECIAL SKILLS:
  
References:
  Give three references who are not relatives or former employers.  
  Name Phone Number Occupation  
   
   
   
Affidavit:
  I authorize without liability, investigation of all statements in this application. I understand that in the event of my employment by the company, it shall be sufficient cause for dismissal if any of the information I have provided in this application is false. I understand that proof of identity and work authorization will be required upon employment in compliance with federal regulations. Until such time as I am called in to meet with the employer and asked to sign a printed affidavit, by typing my name and the date below, I am electronically signing and bound to all statements made on this online application.  
   
  Your full legal name as electronic signature Date (ex. June 3rd, 2007)  
Submit Application:
  By submitting this online application, I confirm all information submitted is accurate to the best of my ability. I acknowledge that there will be additional paperwork for me to complete and sign should I be asked in for an interview. I am providing my email address for a copy of my completed application to be sent to me.  
   
  Email address to receive copy of application