LOUP VALLEY ALFALFA, INC.                                               Employment Application APPLICANT INFORMATION Last Name                                 First                              M.I.                            Date         Street Address                           Apartment/Unit #         City                                          State                             ZIP         Phone                                       E-mail Address         Date Available                           Social Security No.                                Desired Salary         Position Applied for         Are you a citizen of the United States?        YES  0    NO  0    If no, are you authorized to work in the U.S.?  YES  0     NO  0 Have you ever worked for this company?     YES  0    NO  0    If so, when?         Have you ever been convicted of a felony?  YES  0    NO  0    If yes, explain         EDUCATION High School                Address         From                To                Did you graduate?        YES  0        NO  0        Degree         College                Address         From                To                Did you graduate?        YES  0        NO  0        Degree         Other                Address         From                To                Did you graduate?        YES  0        NO  0        Degree         REFERENCES Please list three professional references. Full Name                Relationship         Company                Phone        (           ) Address         Full Name                Relationship         Company                Phone        (           ) Address         Full Name                Relationship         Company                Phone        (           ) Address         PREVIOUS EMPLOYMENT Company                Phone        (           ) Address                Supervisor         Job Title                Starting Salary        $        Ending Salary        $ Responsibilities         From                To                Reason for Leaving         May we contact your previous supervisor for a reference?        YES  0        NO  0         Company                Phone        (         ) Address                Supervisor         Job Title                Starting Salary        $        Ending Salary        $ Responsibilities         From                To                Reason for Leaving         May we contact your previous supervisor for a reference?        YES  0        NO  0         Company                Phone        (         ) Address                Supervisor         Job Title                Starting Salary        $        Ending Salary        $ Responsibilities         From                To                Reason for Leaving         May we contact your previous supervisor for a reference?        YES  0        NO  0         MILITARY SERVICE Branch                From                To         Rank at Discharge                Type of Discharge         If other than honorable, explain         DISCLAIMER AND SIGNATURE I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. Signature:__________________________________                 Date