Online Job Application

Ag Com, Inc. is an equal opportunity employer. We consider applicants for all positions without regard to race, color, religion, sex, national origin, sexual preference or orientation, age (over 40), veteran status, non-job-related disability, or any other characteristics protected by law. Information provided on the application will not be used for any discriminatory purpose.
Your completed application form will be maintained in our active files for (12) months from the date on this application.

NOTICE: AG COM, INC. IS A DRUG-FREE WORKPLACE. ALL APPLICANTS WHO HAVE BEEN EXTENDED AN
OFFER OF EMPLOYMENT WILL BE TESTED FOR THE USE OF ILLEGAL DRUGS.

Online Job Application

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Would you like to fill out an application online or print a pdf and mail it in?

Fill out Online

Print out PDF

Attach your Resume(Required)

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 10 MB, Max. files: 3.

Since you are printing out a PDF application, you can disregard the rest of this form. Please download the PDF below, print, fill out and send to careers@agcominc.com.

PDF Application

Name(Required)

First Middle Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Social Security Number(Required)

Position(s) applied for(Required)

Day or Night Shift?(Required)

Years of Experience(Required)

Have you ever worked for us before? If yes, when?(Required)

Date Available to Start(Required)

List any relatives working with us:(Required)

How were you referred to AgCom? Advertisement, Walk-in, Friend/Relative, School, Other(Required)

Employment History

How many past employments are you entering?(Required)

Employment #1

Employer #1(Required)

Position(s)(Required)

City/State(Required)

Supervisor Name and Title(Required)

Date Started(Required)

Date Ended(Required)

Beginning Pay Rate(Required)

Ending Pay Rate(Required)

Description of Work(Required)

Reason for Leaving(Required)

Employment #2

Employer #2

Position(s)

City/State

Supervisor Name and Title

Date Started

Date Ended

Beginning Pay Rate

Ending Pay Rate

Description of Work

Reason for Leaving

Employment #3

Employer #3

Position(s)

City/State

Supervisor Name and Title

Date Started

Date Ended

Beginning Pay Rate

Ending Pay Rate

Description of Work

Reason for Leaving

Please give a brief explanation for any gaps in employment:

Are there any shifts that you are not willing to work?(Required)

Yes

Will you work overtime if asked?(Required)

Yes

Personal References

References

Name and Occupation

Address

Phone Number

Please list three persons who are not related to you and who have knowledge of your qualifications for the position(s) for which you are applying. Do not repeat names of supervisors listed above.

Experience/Qualification

Are you applying for a driver position?(Required)

Yes

Licenses(Required)

State

LIcense No.

Class

Endorsement(s)

Expiration Date

Licenses held in past 3 years must be shown

Have you ever been denied a license, permit, or privilege to operate a motor vehicle?(Required)

Yes

Has any license, permit, or privilege ever been suspended or revoked?(Required)

Yes

Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulation?(Required)

First Choice

Driving Experience

Class of Equipment(Required)

Straight Truck

Tractor and Semi-Trailer

Twin Trailers - LVC's

Other

For Straight Truck

Type of Equipment (Van, Tank, Flat, Etc.)

From

Approximate Total Miles

For Tractor and Semi-Trailer

Type of Equipment (Van, Tank, Flat, Etc.)

From

Approximate Total Miles

For Twin Trailers - LVC's

Type of Equipment (Van, Tank, Flat, Etc.)

From

Approximate Total Miles

Other

Type of Equipment (Van, Tank, Flat, Etc.)

From

Approximate Total Miles

List states operated in during last five years:(Required)

List special courses or training that will help you as a driver(Required)

List driving awards held and who awards were presented by:(Required)

Accident Review For the Past 3 Years

Dates

Nature of Accident (headpon, rear-end, overturn, etc.)

Fatalities

Injuries

Traffic Convictions and Forfeitures for the Past 3 Years (Other than parking violations)

Location

Date

Charge

Penalty

Platform Experience and Qualifications

List types of platform experience and number of years each(Required)

List platform equipment you can operate (lift truck, etc.):(Required)

List courses or training in platform work(Required)

Education

List our Education(Required)

Type of School (High School, College, etc)

Name & Location (City/State)

Years Attended

Course of Major

Did you receive a Diploma or Degree

Have you ever served in the Armed Forces?(Required)

Yes

Which Branch?(Required)

Rank at Discharge(Required)

Years of Service From(Required)

Years of Service To(Required)

Job Specialization(Required)

Duties(Required)

Special Training(Required)

Special Skills

If relevant, please describe word processing speed, software knowledge, and office equipment experience.

Certifications/Designations/Licenses

Courses

Certifications

Expiration Date

Have you ever been convicted, pleaded guilty, or NOLO CONTENDERE (no contest) to a felony or a misdemeanor?(Required)

Yes

Please explain the details and date of conviction (if necessary, you may attach a separate sheet of paper). Conviction of a crime is not an automatic bar to employment- all circumstances will be considered.(Required)

Consent(Required)

I agree to the following

I hereby certify that the answers and any other information on this application are true and correct, and that I understand any
misrepresentation or omission of facts on my part will be justification for termination from Ag Com, Inc. if I am employed.
I hereby authorize Ag Com, Inc. to investigate my previous record of employment or educational experience to determine any and all
information of concern to my record, and I release employers and persons named in my application from all liability for any damages on
account of his/her furnishing said information.
I understand that nothing in this application or in the granting of an interview is intended to create a guarantee of employment, or an
employment contract between Ag Com, Inc. and myself. If an employment relationship is established, I hereby understand and
acknowledge: 1) That any employment relationship with Ag Com, Inc. is of an “at-will” nature, which means that I have the right to
terminate my employment at any time for any reason and that Ag Com, Inc. retains the same right. 2) After discussion and reasonable
notice, my hours of employment may change based on the business needs of Ag Com, Inc.
In the event that I am offered and accept a position with Ag Com, Inc., I understand that I am expected to comply with Ag Com, Inc.
policies and other communications distributed to all employees. I acknowledge that Ag Com, Inc. reserves the right to amend or modify
the policies in its employee handbook and other policies at any time, for any reason, without prior notice.
In consideration of my being considered for employment and/or being employed, I hereby agree to submit to physical examinations and
test, including drug or alcohol tests, as may be required by Ag Com, Inc. I hereby release Ag Com, Inc. from any liability from its use of
these examinations, tests or related reports in connection with my application and/or employment, or with regard to the defense of any
legal action or proceeding.

Name(Required)

Signature(Required)

Your Name
Your Name
Your Name

Note: If you are employed by Ag Com, Inc., you will be required to provide documentation of your identity and eligibility to work in the United States as required by Federal Law. Applicant: Complete the release form for the former employers so that your record can be released for our use concerning your application.

Online Job Application

Online Job Application

Employment History

Employment #1

Employment #2

Employment #3

Personal References

Experience/Qualification

Driving Experience

Platform Experience and Qualifications

Education

Special Skills

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