Employment Application Step 1 of 6 16% NameThis field is for validation purposes and should be left unchanged.Name* First Middle Last Email* Enter Email Confirm Email Phone*Best Time to Call : Hours Minutes AM PM AM/PM Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Application Date* MM slash DD slash YYYY Position Applying for*Select a position...Regional Manager - DHI & AIArea Sales Manager - Northwest WisconsinArea Sales Manager - Northern IndianaFull-time Milk Sample Technician, Kaukauna, Wis.Part-time A.I. Specialist - WisconsinA.I. Specialist - general locationDHI Specialist - general locationMilk-Sample Technician - general locationThis field is hidden when viewing the formPosition(s) Applied forHow did you hear about CentralStar? Facebook Instagram LinkedIn Youtube Indeed Internet search Morning Ag Clips Dairy Star newspaper College job board State/public job board Career Fair Professor/instructor CentralStar website A.I.-cattle-breeding training Current employee Other Career Fair (if yes, where?)Professor/instructor (If yes, who?)Current employee (If yes, who?)Other (enter details)Upload a ResumeAccepted file types: pdf, docx, pages, Max. file size: 256 MB. Upload a Cover LetterAccepted file types: pdf, docx, pages, Max. file size: 256 MB. Applicant InformationIf you are under 18, can you provide a work permit?Please Select...YesNoN/AHave you applied with CentralStar before?Please Select...YesNoAre you legally eligible for employment in the U.S.?(Proof of U.S. Citizenship or Immigration Status may be required upon employment)Please Select...YesNoDate available for work MM slash DD slash YYYY Type of employment desired: Full Time Part Time Temporary Seasonal Are you currently on layoff and subject to recall?Please Select...YesNoWill you relocate if the job requires it?Please Select...YesNoWill you travel if the job requires it?Please Select...YesNoAre you able to meet the attendance requirements for the position?Please Select...YesNoWill you work overtime if needed?Please Select...YesNoHave you ever been bonded?Please Select...YesNoHave you ever been convicted of, or pled guilty or no contest to, a crime other than a minor traffic violation?Please Select...Yes*NoPlease send a confidential email to carol.stevens@mycentralstar.com, Director of Human Resources. Include the date of final disposition of the case and the nature of the offense. This information does not automatically disqualify you from employment but false or misleading information will. Factors such as job relevance, age and time since the offense, seriousness and nature of the violation, and rehabilitation will be taken into account. Employment HistoryBeginning with the most recent.EmployerEmployer PhoneEmployer Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country SupervisorJob TitleStarting SalaryEnding SalaryReason for leavingResponsibilitiesDo you have a non-compete or other employment agreement with this employer?Please Select...YesNoMay we contact this employer?Please Select...YesNoWould you like to add another job?Please Select...YesNoEmployerEmployer PhoneEmployer Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country SupervisorJob TitleStarting SalaryEnding SalaryReason for leavingResponsibilitiesDo you have a non-compete or other employment agreement with this employer?Please Select...YesNoMay we contact this employer?Please Select...YesNo Educational BackgroundName of High SchoolDegree / Diploma Received?Please Select...YesNoName of CollegeDegree / Diploma Received?Please Select...YesNoField of StudyNumber of years completedTechnical SchoolDegree / Diploma Received?Please Select...YesNoField of StudyNumber of years completedOther TrainingLanguage SkillsPlease list languages you speak.Skill Level in that language Speak Some Speak Fluently Read Write Work-related ReferencesList information for business/work references that are NOT related to you and are not previous supervisors. If not applicable, list three school or personal references not related to you. Reference 1 NameReference 1 OccupationReference 1 Years KnownReference 1 Phone or Contact InformationReference 2 NameReference 2 OccupationReference 2 Years KnownReference 2 Phone or Contact InformationReference 3 NameReference 3 OccupationReference 3 Years KnownReference 3 Phone or Contact Information Other informationSkills and QualificationsSummarize any special training, skills, licenses, and/or certifications that may qualify you as being able to perform the job-related functions of the position for which you are applying.Professional OrganizationsList professional, trade, or business associations relevant to the position you’ve applied for including offices held.List other accomplishments, publications and awards.List any other information you would like us to consider that is relevant to this position.CentralStar Cooperative, Inc. StatementCentralStar Cooperative, Inc. is an Equal Opportunity Employer and does not discriminate in employment. No question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state or federal law. It is also CentralStar Cooperative, Inc.’s policy not to refuse to hire a qualified individual with a disability because of a need for reasonable accommodation as required by the ADA. This application is current and active for a period of 60 days. At the conclusion of this time, if you have not heard from CentralStar Cooperative Inc. and still wish to be considered for employment, it will be necessary to submit a new application.* I have read the above statement Applicant's StatementPlease read this statement carefully before submitting this application.I understand that as an at-will employee, I am free to resign at any time just as CentralStar Cooperative reserves the right to terminate my employment at any time, with or without cause and without prior notice as is consistent with applicable state or federal law. I understand that no representative of the employer has the authority to make any assurances to the contrary. I authorize CentralStar Cooperative, Inc. to conduct a thorough background investigation of my work and personal history, and verify all data given on this application and during interviews. I hereby release CentralStar Cooperative, Inc., and its representatives or agents, from any liability that might result from such an investigation. I authorize all individuals, schools, and firms named to provide any requested information and release them from all liability for providing the requested information. I attest that I am not restricted by a signed contract or other agreement with former employers which include provisions that could preclude, prohibit or restrict the terms and conditions of my employment with CentralStar Cooperative, Inc. without having fully disclosed and provided a copy of said document to CentralStar Cooperative, Inc. prior to any offer of employment. I understand it is my responsibility to honor and comply with any outstanding agreements and to make CentralStar Cooperative, Inc. aware of their existence. This includes but may not be limited to non-compete agreements, non-solicitation agreements, and/or restrictive covenants.* I certify that all the statements in this completed application are true and understand that any falsification, misrepresentation, or willful omission shall be sufficient cause for cancellation of this application, including refusal to hire, and/or termination of employment if I have been employed. Click 'Submit' only once and do not exit screen. Form may take a moment to save and move to next screen. Δ
