Employment Application

Employment Application

Applicant Information

First, Last

Street, City, State, Zip

Home or cell, best number to reach you!

Are you 18 years of age or older?
Position Applying For:
This position involves heavy lifting, do you have any lifting limitations?
Have you had any previous injury or surgery to your back or neck?
Have you ever been previously employed by Agway?
Have you ever been convicted of a felony? (Record of conviction does not automatically disqualify applicant from employment consideration.)


Previous Employment


Agway is committed to a Drug Free workplace. Applicants may be required to pass a drug screening test as a condition of employment. AGWAY IS AN EQUAL OPPORTUNITY EMPLOYER: Agway believes in providing equal opportunity for all and will not discriminate against any individual on the basis on race, color, religion, sec, national origin, age, disability or veteran’s status. All applications kept on file for 30 days.

I certify that the information on this application is true and correct to the best of my knowledge and I understand that any misrepresentation or omission of fact shall be cause for disqualification for employment or dismissal from employment. I hereby authorize an investigation of statements contained in the application and release from all liability and claims all persons and companies supplying information. I understand that my employment with the company would not be for any fixed period of time and that, if employed, I may resign at any time for any reason or the company my terminate my employment at any time for any reason.