Archer Daniels Midland Company and Subsidiaries
ADM EMPLOYMENT APPLICATION
“An Equal Opportunity Employer”
Archer Daniels Midland Company
♦
P.O. Box 1470 ♦ Decatur, Illinois 62526
Do not answer questions, which may be contrary to existing laws or regulations.
Application Date:
Position Desired:
Name (Last, First, Middle):
Present Address:
City, State Zip:
Permanent Address:
If different from above
City, State Zip:
If different from above
Present Phone: (
)
Alternate Phone: (
)
Business Phone/Extension:
(
)
Email Address:
Education
Circle Last Grade Completed: 9 10 11 12 13 14 (Degree – Associate, Bachelor, Master’s, PhD)
Do you have a High School Diploma or GED:
Yes
No
In the spaces below, please enter schools you have attended, dates attended, degrees received, grade point, and
your primary area of study. Please list highest degrees first.
Course of
Grade Point
School Name
School Location
Type of Degree
Study/Major
Average
Professional Licenses and Certificates
In the spaces below enter any licenses and certificates relative to the position you are applying.
Date
License/Certificate
Type
State Issued
Date Expires
Issued
Form 4404 Rev. (07-07)
Equal Opportunity Employer
1
Archer Daniels Midland Company and Subsidiaries
Foreign Languages
Please list any foreign languages in which you are proficient AND which you would be willing to use on the job:
Foreign Language
Read
Write
Speak
Yes /
No
Yes /
No
Yes /
No
Yes /
No
Yes /
No
Yes /
No
Work History
Start with most recent employer.
Employment Dates:
From
To
Position Title:
Name of Company:
Phone Number:
(
)
Address:
Duties and
Responsibilities:
Reason for Leaving:
Supervisor Name:
May we contact the Supervisor?
Yes
No
Supervisor Title:
Starting Salary
Annually / Hourly
Bonuses:
Ending Salary
Annually / Hourly
Incentives:
Employment Dates:
From
To
Position Title:
Name of Company:
Phone Number:
(
)
Address:
Duties and
Responsibilities:
Reason for Leaving:
May we contact the Supervisor?
Form 4404 Rev. (07-07)
Supervisor Name:
Yes
No
Supervisor Title:
Equal Opportunity Employer
2
Archer Daniels Midland Company and Subsidiaries
Starting Salary
Annually / Hourly
Bonuses
Ending Salary
Annually / Hourly
Incentives
Employment Dates:
From
To
Position Title:
Name of Company:
Phone Number:
(
)
Address:
Duties and
Responsibilities:
Reason for Leaving:
Supervisor Name:
May we contact the Supervisor?
Yes
No
Supervisor Title:
Starting Salary
Annually / Hourly
Bonuses:
Ending Salary
Annually / Hourly
Incentives:
Employment Dates:
From
To
Position Title:
Name of Company:
Phone Number:
(
)
Address:
Duties and
Responsibilities:
Reason for Leaving:
May we contact the Supervisor?
Supervisor Name:
Yes
No
Supervisor Title:
Starting Salary
Annually / Hourly
Bonuses
Ending Salary
Annually / Hourly
Incentives
Form 4404 Rev. (07-07)
Equal Opportunity Employer
3
Archer Daniels Midland Company and Subsidiaries
Please attach additional sheet if necessary
Related Questions
Are you able to submit verification of your right to work in the United States in the
event an offer of employment is made to you?
Yes /
No
Proof of your right to work in the United States will be required as a condition of
employment in the event you are offered a position.
Are you seeking: (check the appropriate box)
Full Time
Minimum Salary Expected
Part Time
Full Time or Part Time
$
Have you signed any agreement or made a promise not to solicit the customers of any former
employer?
Have you signed any agreement not to disclose information obtained while employed by or
working for any other employer? (i.e. trade secrets)
Have you ever been convicted of any felonies for which the record has not been judicially
expunged, sealed or eradicated? If yes, Please explain:
Yes
Yes
Yes
/
No
/
No
/
No
(Criminal convictions will not be an absolute bar to employment with this company.)
If necessary will you work?
Overtime /
Shift work
/
Saturdays
/
Sundays
(Shift work may be Swing Shift, Rotating Shifts, 1st, 2nd, 3rd or a variation.)
Date you anticipate making an employment decision:
Date you would be available to start working:
Would you be willing to relocate?
Are you under 18 years of age?
Yes
/
No
Location Preferred?
Are you able to travel overnight as required by this position?
Yes
/
No
What are your qualifications
and/or training for the type
of work you are applying
for?
How did you hear about this opportunity?
Have you ever worked for ADM?
Type of Work?
Form 4404 Rev. (07-07)
Yes
/
No
If yes, what dates?
Location?
Equal Opportunity Employer
4
Archer Daniels Midland Company and Subsidiaries
Are you currently on “lay-off” status from another employer and subject to recall?
Yes
/
No
References
List three persons to whom you are not related who are qualified to judge your training or capabilities. You
should refer to academic, professional or business references only.
Name
Home or Business Address
Phone
(
)
(
)
(
)
Occupation
Years
Known
Information Acknowledgement
PLEASE READ BEFORE SUBMITTING YOUR APPLICATION
I understand that false or misleading statements in this application will be sufficient cause for dismissal if
employed by ADM. I authorize investigation of all matters contained in this form, including authority to
request a college transcript, and agree that if, in the judgment of the company, any misrepresentation has
been made by me herein or the results of such investigations are not satisfactory to the company, any offer
of employment made by the company may be withdrawn. If employed by the company, my employment
may be terminated immediately, without any obligation or liability to me other than for payment at the rate
agreed upon for services actually rendered.
I understand and agree that unless otherwise specifically stated in writing and confirmed by the Human
Resources Department of the Company, any employment granted to me by the Company is at will and for
an indefinite term and that such employment may be terminated at any time either by me or by the
Company for any or no reason whatsoever, unless the terms of my employment are otherwise governed by
a collective bargaining agreement.
I have carefully read the above Information Acknowledgement and I understand and
agree to all the statements.
Date: ________________________
Form 4404 Rev. (07-07)
Yes / No
Signature: _________________________________________
Equal Opportunity Employer
5
Archer Daniels Midland Company and Subsidiaries
Applicant/New Hire Data Sheet for Equal Opportunity Statistics
To meet governmental recordkeeping and reporting requirements, ADM invites applicants and employees to complete this data
sheet. The completion of this form is voluntary, and refusal to provide the information requested will not subject you to any
adverse treatment. This information will be kept confidential and only used in accordance with the provisions of applicable laws,
executive orders and federal regulations.
Please Print:
Last Name:
First Name:
Street Address:
City:
Middle Initial:
State:
Zip Code:
Gender Data:
□Male
□Female
Race/Ethnic Data:
Please check only one box. Do not insert additional groups.
□Hispanic or Latino: Persons having origins in Mexico, Puerto Rico, Cuba, Central or South America, or other Spanish cultures
or origin regardless of race. This does not include persons of Portuguese descent or persons from Central or South America who
are not a Spanish origin or culture.
□White: (not Hispanic or Latino):
Persons having origins in Europe, North Africa, or the Middle East.
□Black or African American (not Hispanic or Latino): Persons having origins in the Black racial group of Africa, as well as
Jamaica, Trinidad, or the West Indies.
□Native Hawaiian or other Pacific Islander (not Hispanic or Latino): Persons having origins in any of the peoples of Hawaii,
Guam, Samoa, or other Pacific Islands.
□Asian/Pacific Islander (not Hispanic or Latino): Persons having origins in the Far East, Southeast Asia, the Indian
Subcontinent, or the Pacific Islands, including for example, China, Japan, Korea, the Philippine Islands and Samoa; and, on the
Indian Subcontinent includes India, Pakistan, Bangladesh, Sri Lanka, Nepal, Sikkim, and Bhutan.
□American Indian or Alaskan Native (not Hispanic or Latino): persons having origins in North America, and who
maintained cultural identification through tribal affiliation or community recognition as an American Indian or Alaskan Native.
□Two or More Races (not Hispanic or Latino):
All persons who identify with more than one of the above races.
Applicant Signature:
Date:
Attn: This form must be removed from the application prior to consideration.
Form 4404 Rev. (07-07)
Equal Opportunity Employer
6