Online Application

Application for Employment
Thank you for your interest in working at Minnesota Dehydrated Vegetables, Inc.
Please complete this application in its entirety. Your opportunity for employment with MDV will depend on the completeness and accuracy of the information on this form. MDV will keep your application on file for a period of two years following the date of this application. Minnesota Dehydrated Vegetables, Inc. is an Affirmative Action, Americans with Disabilities, Equal Opportunity Employer and fully complies with all laws that prohibit discrimination. This form is available in alternative formats for applicants with a disability. Please notify Human Resources if you require a reasonable accommodation in the application process.

Name: *

First

Last

Position Applying For: *

Street Address: *

Email: *

Today's Date: *

City: *

State: *

Zip Code: *

Home Phone: *

Cell Phone: *

Dates Available for work: *

Salary or hourly rate desired: *

Are you 18 years of age or older? *

Are you authorized to work in the United States without sponsorship? *

Are you presently employed? *

Yes No

If not presently employed, date last worked: *

Are you willing to work? *

If required for this position, do you have a current, valid driver's license? *

Yes No

Have you ever been employed by MDV? *

Yes No

If yes, date last worked at MDV: *

Reason for leaving: *

Have you ever been discharged or forced to resign from a position? *

Yes No

If you have been discharged or forced to resign, provide details: *

Have you applied for a position with MDV before? *

Yes No

If yes, date of application: *

How did you hear about this position? *

Employment History: Please list your current and two previous employers, assignments, internships, or volunteer activities, start with the most recent employer

Employer: *

Phone Number: *

Address: *

Start date: *

End date: *

Beginning Pay: *

Ending Pay: *

Position: *

Responsibilities: *

Supervisor: *

May we contact employer? *

Yes No

Reason for leaving: *

Employer *

Phone Number: *

Address: *

Start date: *

End date: *

Beginning Pay: *

Ending Pay: *

Position: *

Responsibilities: *

Supervisor: *

May we contact employer? *

Yes No

Reason for leaving: *

Employer: *

Phone Number: *

Address: *

Start date: *

End date: *

Beginning Pay: *

Ending Pay: *

Position: *

Responsibilities: *

Supervisor: *

May we contact employer? *

Yes No

Reason for leaving: *

Skills and Training:

Summarize any training, certifications, licenses, and skills that you feel would help you qualify for a position with MDV: *

Education:

High School/GED

Name, City & State *

Did you complete/graduate? *

College or University

Name, City & State *

Did you complete/graduate? *

Degree or courses studied: *

Other Education or Training

Name, City & State *

Did you complete/graduate? *

Degree or type of accomplishment: *

References: Do not include friends or relatives. Valid references will include professional contacts, co-workers, teacher, etc.

Name: *

Phone number: *

Years known: *

Relationship: *

Name: *

Phone number: *

Years known: *

Relationship: *

Name; *

Phone number: *

Years known: *

Relationship: *

Applicant's Certification

I understand that Minnesota Dehydrated Vegetable, Inc. (MDV) is an "at-will employer" and if I am hired, my employment may be terminated at the will of either party, with or without cause, and without prior notice.

MDV is an Affirmative Action, Americans with Disabilities, Equal Opportunity Employer. Qualified applicants are considered without regard to race, religion, creed, color, national origin, citizenship, marital status, sex, age, sexual orientation, gender identity, veteran status, political ideology, ancestry, the presence of any physical, sensory, or mental disabilities, or other legally protected status.

I authorize MDV to conduct a thorough background investigation of my employment and educational history and verify all data given on this application and during interviews. I hereby release MDV and its representatives or agents, from any liability that might result from such an investigation. I authorize all individuals and firms named to provide any requested information and release them from all liability for providing the requested information.

I certify that all statements on this application are complete and correct to the best of my knowledge. I understand that failure to complete any required item on this application or providing false information may be cause for rejection of my application or cause for dismissal from my employment whenever discovered. I also understand that if I fail to sign this statement my application cannot be considered for employment.

I understand that if I am selected, based on position requirements, I will be required to submit to and pass a pre-employment drug screening and/or criminal background search and/or history or physical fitness test as a condition of employment.

I have read and understand the above certification statement. Further, I have reviewed the position description for this position and certify that I am able to perform the essential functions listed, with or without a reasonable accommodation. Please accept my application for employment with Minnesota Dehydrated Vegetables, Inc.

By typing my name, I agree with the above statements. *

Affirmative Action: Voluntary Self Identification Form

Minnesota Dehydrated Vegetables, Inc. is an Equal Opportunity Employer. As required by law, we must record certain information to be made a part of our Affirmative Action Program. Applicants for employment are also invited to participate in the Affirmative Action Program by reporting their status as disabled, disabled veteran, veteran of the Vietnam era or other minority. In extending this invitation you are also advised that: (a) workers (applicants) are under no obligation to respond, but may do so in the future if they choose; (b) responses will remain confidential within the Human Resources Department; and (c) responses will be used only for the necessary information to include in our Affirmative Action Program. We are a company that values diversity. We actively encourage women and minorities to apply. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment.

Section 1: General Applicant Information

Name *

First

Last

Date: *

Position applied for: *

Section 2: Please check all that apply (see bottom for definitions)

I do NOT wish to Self-Identify *

Select if you do not wish to Self-Identify

Race or Ethnic Identity *

Gender *

Individual with Disabilities: *

No Yes

Veteran Status: *

By typing my name, I agree with the above information: *

EEOC RACE/ETHNIC IDENTIFICATION CATEGORIES

Hispanic or Latino- A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

White (Not Hispanic or Latino)- A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American (Not Hispanic or Latino)- A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)- A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Asian (Not Hispanic or Latino)- A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

American Indian or Alaska Native (Not Hispanic or Latino)- A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.

Two or More Races (Not Hispanic or Latino)- All persons who identify with more than one of the above five races.

Individual with Disabilities- Defined as a person who (1) has a physical or mental impairment which substantially limits one or more of his or her major life activity(s), (2) has a record of such impairment(s), or (3) is regarded as having such impairment(s). For purposes of this definition, an individual with disability(s) is substantially limited if he or she is likely to experience difficulty in securing, retaining, or advancing in employment because of the disability(s).

Veteran of the Vietnam-Era- Defined as (a) an active duty wartime or campaign badge 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. (b) an Armed Forces service medal 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 (61 FR 1209).

Disabled Veteran- Defined as (1) 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 (2) a person who was discharged or released from active duty because of a service-connected disability.

Special Disabled Veteran- Defined as a veteran 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 Department of Veterans Affairs for a disability:
1.     Rated at 30 percent or more; or
2.     Rated at 10 or 20 percent in the case of a veteran who has been determined under Section 38 U.S.C. 3106 to have a serious employment handicap; or
3.     A person who was discharged or released from active duty because of a service connected disability.

Veteran of the Vietnam Era-Defined as a person who served on active duty for a period of more than 180 days, and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred:

·In the Republic of Vietnam between February 28, 1961, and May 7, 1975; or
·Between August 5, 1964, and May 7, 1975, in all other cases;
·Was discharged or released from active duty in the U.S. military, ground, naval or air service for a service connected disability if any part of such active duty was performed (A) in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (B) between August 5, 1964, and May 7, 1975, in all other cases.

Recently Separated Veteran- Any veteran who served on active duty in the U.S. military, ground, naval or air service during the one year period beginning on the date of such veteran’s discharge or release from active duty.

Pre-JVA Veteran- Defined as an individual who is an employee of or applicant to a contractor with a contract of $25,000 or more entered into prior to December1, 2003 and unmodified since to $100,000 or more, and who is a special disabled veteran, veteran of the Vietnam era, pre-JVA recently separated veteran, or other protected veteran.

Armed Forces Service Medal Veteran- Defined as any veteran who, while serving on active duty in the U.S. military, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Active Duty or Wartime Campaign Badge Veteran- Defined as 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 laws administered by the Department of Defense.