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Job Application
 
United Cooperative Application for Employment

United Cooperative is an equal opportunity employer. United Cooperative does not disciminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, marital status, sexual orientation, national origin, disability or handicap, veteran status, or any other basis prohibited by federal or state law.

Please note that in many of the boxes in this application, you are able to choose more than one option. You do this by holding down the "Ctrl" key while clicking the options with your mouse. Examples of boxes where you can choose more than one option include shifts you're available to work, office machines you can operate, etc.

This application must be completed to the fullest extent possible to be considered for a position. "See résumé" is not an acceptable response.  Applications stating "see résumé" will not be considered.

Personal information

 

Last Name  
First Name (no nicknames, please)  
Middle Name  
Home Address  
City  
State  
Zip Code  
E-mail Address  
Home Phone  
Cell Phone  
Business Phone  
May we contact you at work? 
Position you are applying for (if known)  
Location (if known)  
Desired Schedule  
For part-time positions, what shifts are you available (Hold down the control key to choose more than one shift)?  
Are you willing to relocate? 
Are you willing to travel? 
If you are willing to travel, what % of time? 
Are you legally authorized to work in the U.S.? 
Are you at least 18 years of age? 
If under 18, do you have a current work permit? 
Have you worked for United Cooperative before? 
If yes, when?  
Do you have relative(s) who work for United Cooperative? 
If yes, what is the relationship?  
Do you have a valid drivers license? 
Drivers License State and Number  
__________________________ 


Education



High School
Name of school  
City, State & Zip Code  
Area of Study  
GPA  
Did you graduate?  
 

 

College or Technical School

Name of school  
City, State & Zip Code  
Area of Study  
GPA  
Did you graduate?  
Degree Earned (i.e. B.A.)  
 

 

Graduate School

Name of school  
City, State & Zip Code  
Area of Study  
GPA  
Did you graduate?  
Degree Earned  
 

 

GED or Other

Name of school  
City, State & Zip Code  
Area of Study  
GPA  
Did you graduate?  
Degree Earned  
 

 

__________________________ 

SPECIAL SKILLS

Typing Speed (WPM)  
Office machines you can operate  
Are you PC (computer) literate? 
Software I am proficient at  
Other  
Do you have a commercial drivers license (CDL)? 
If yes, choose class(es)  
License state and exp. date  
Are you an experienced operator of  
Other  
Please list foreign languages you know  
Indicate any other special skills or training  
 

__________________________ 

EMPLOYMENT HISTORY

List employment, starting with your current employment or your most recent employment.   

Reminder:  "See Resume" is not an acceptable response.  Applications stating "See Resume" will not be considered.

Job #1

Name of Employer  
Address  
Telephone Number  
Job Title  
Start Date  
End Date  
Start Pay ($__ per __)  
End Pay ($__ per __)  
Job Duties  
Supervisor's name and title  
May we contact him or her? 
Reason for leaving  
 

 

Job #2

Name of Employer  
Address  
Telephone Number  
Job Title  
Start Date  
End Date  
Start Pay ($__ per __)  
End Pay ($__ per __)  
Job Duties  
Supervisor's name and title  
May we contact him or her? 
Reason for leaving  
 

 

Job #3

Name of Employer  
Address  
Telephone Number  
Job Title  
Start Date  
End Date  
Start Pay ($__ per __)  
End Pay ($__ per __)  
Job Duties  
Supervisor's name and title  
May we contact him or her? 
Reason for leaving  
 

 

Job #4

Name of Employer  
Address  
Telephone Number  
Job Title  
Start Date  
End Date  
Start Pay ($__ per __)  
End Pay ($__ per __)  
Job Duties  
Supervisor's name and title  
May we contact him or her? 
Reason for leaving  

 

Please explain and/or indicate your activity during any unemployed time period, so there are no gaps in the record of past employment above.

 
 

__________________________ 

WORK REFERENCES

Please give three references of people who can verify your work experience, skills or other characteristics related to the job for which you are applying. 

 

Reference #1
Name and Title  
Relationship  
Years Known  
Telephone Number  
Address  
 

 

Reference #2

Name and Title  
Relationship  
Years Known  
Telephone Number  
Address  
 

 

Reference #3

Name and Title  
Relationship  
Years Known  
Telephone Number  
Address  
 

__________________________ 

LEGAL

 

Have you ever been convicted of a misdemeanor or felony? 
If yes, please explain  
Note:  A "yes" answer does not automatically bar you from employment and is only considered as it relates to the specific job for which you are applying or being considered for.
Have you signed a no-compete or confidentiality agreement that is in effect and may prevent you from working freely for United Cooperative? 
Are you related to a member of the United Cooperative Board of Directors? 
If yes, please explain relationship  
Where did you hear about this employment opportunity?  
 

 

__________________________ 

 

CERTIFICATION and TERMS

You must read and agree with the "certification and terms" before submitting the application. If you do not mark "Yes" acknowledging you have read and and agree with the "certification and terms," your application will not be considered for employment. 

Click here to read the "certification and terms."

Do you accept the Certification and Terms? 
By typing your name, the date, and your initials below, you are signing your electronic signature and stating, once again, that you have read and agree with the "certification and terms," and the information you've provided in your application above is accurate and current with no intention to mislead United Cooperative or misrepresent yourself.

Full Name  
Today's Date  
Your Initials  

Thank you for applying for a position with United Cooperative. Please click the "submit" button below to upload your application. 
Please type the text in the box.


   
  

 
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