« back to Main Street Ingredients site 
 
Application for Employment
 

Main Street Ingredients is an equal employment opportunity employer dedicated to a policy of non-discrimination in employment based upon an individual’s race, color, creed, religion, age, sex, national origin, ancestry, marital status, sexual orientation, disability, arrest/conviction record, or any other status protected under the law.

You will have the opportunity to add up to three attachments (résumé, cover letter, references) at the end of this form. Acceptable file formats are PDF and Word documents.

 *required field 
 
* Prefix:
  
* First Name:
  
* Middle Initial:
 
* Last Name:
 
Date of Application:
   mm/dd/yyyy
* Address:
 
* City:
  
* State:
  
* Zip Code:
 
* Country:
  
* Phone:
 
Cell:
  
Work Phone:
  
* Email:
 


  How did you hear about us?
  Radio Ad Newspaper Ad Website Main Street Employee Website
  Employment Agency Relative Other


* Position(s) Applied for:
 
* Are you available to work:
  
* Shift Preference (check all that apply):
   1st 2nd 3rd
* Possible starting date:
  


If hired, can you furnish proof that you are 18 years of age, or if under 18, do you have a permit to work?YesNo
If no, Please explain:
If hired, can you furnish proof that you are eligible to work in the United States?YesNo
Have you ever applied for a job with this company in the past?YesNo
If yes, please give the date of application and the position for which you applied. State your name at that time, if different from present name.
Have you ever been employed by this company in the past?YesNo
If yes, please give dates of employment, position(s) held, and state your name while employed if different from present name.
Are you currently employed?YesNo
May we contact your current employer?YesNo
Are you currently on “lay-off” status and subject to recall?YesNo
If hired, do you have transportation means readily available to come to your scheduled work each day?YesNo
Can you travel if a job required it?YesNo
Have you been convicted of a misdemeanor or felony, except for minor traffic offenses, or released from prison in the past 7 years? Note: A yes answer does not automatically disqualify you from employment since the nature of the offense, date, and type of job for which you are applying will be considered.YesNo
If yes, Please explain:


Employment Experience
 
Start with your present or most recent employer first
 
Employer:
  
Employment Starting Date:
  
Employment Ending Date:
  
Employer Address:
  
Employer Telephone:
  
Starting Salary:
  
Ending Salary:
  
Title:
  
Supervisor:
  
Work Performed:
  
Reason for Leaving:
  
May we contact:
   YesNo
 
Employer:
  
Employment Starting Date:
  
Employment Ending Date:
  
Employer Address:
  
Employer Telephone:
  
Starting Salary:
  
Ending Salary:
  
Title:
  
Supervisor:
  
Work Performed:
  
Reason for Leaving:
  
May we contact:
   YesNo
 
Employer:
  
Employment Starting Date:
  
Employment Ending Date:
  
Employer Address:
  
Employer Telephone:
  
Starting Salary:
  
Ending Salary:
  
Title:
  
Supervisor:
  
Work Performed:
  
Reason for Leaving:
  
May we contact:
   YesNo
 
Employer:
  
Employment Starting Date:
  
Employment Ending Date:
  
Employer Address:
  
Employer Telephone:
  
Starting Salary:
  
Ending Salary:
  
Title:
  
Supervisor:
  
Work Performed:
  
Reason for Leaving:
  
May we contact:
   YesNo


Education School
Name/Address		 Course of Study Years Completed Diploma/Degree
High School
Undergraduate
Graduate
Other (specify)

Describe any specialized training, apprenticeship, skills, and extra-curricular activities (include military)

Some people gain job-related experience in positions other than as an employee. For instance, an accountant may gain experience as a treasurer of a civic or school organization, or a manager may gain experience while working on civic projects, or in school organizations, or in PTA activities. Please list and describe any paid or unpaid activities, honors, experience, or training that might aid you in performing the job(s) for which you have applied, and have not been listed previously in this application. (You may omit any activities, honors, memberships or other items that tend to identify your race, sex, national origin, age, disability or other personal traits that you prefer not to disclose.)

Specialized Skills (Check Skills/Equipment Operated)
CRT Fax PC Typewriter
Calculator Excel Word  
Production/Mobile: Machinery List
Other:

Please add any additional information (except that which identifies your race, sex, age, religion, national origin, disability or other non-job-related personal information) that you think may be relevant to a decision to hire you.

References
 


Add Attachments (optional) You may add up to three attachments, if desired. Recommended attachments might include a résumé, cover letter and references. Acceptable file fomats are PDF and Word documents
 
Add Attachment 1:
  
Add Attachment 2:
  
Add Attachment 3:
  

Applicant’s Statement
 
I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization such as collective bargaining agreements. I understand that as a part of being considered for employment by Main Street Ingredients, I will be required to undergo a physical examination which will include urine testing for drugs. I further understand that any employment offer is contingent upon my passing this examination and drug screen. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of this employer.

I have read, understand and agree to the terms stated above.
Main Street Ingredients 2340 Enterprise Avenue
La Crosse, WI 54603-1713		 Toll Free: 800-359-2345 • Phone: 608-781-2345 • Fax: 608-781-4667
Email: info@mainstreetingredients.com © 2007 Main Street Ingredients