Dairy Employee Request APS Representative's Name Business Name (required) Physical Address (required) Mailing Address (if different) Business Federal ID# (required) Business Entity Type (required) - Individual Corporation Partnership LLC Other Contact Person (required) Phone # (required) Fax Number Cell Phone # (required) E-mail Address (required) Milk Company Name (required) Milk Company Producer ID Number (required) Milk Company Contact Person (required) Milk Company Contact Phone Number (required) Names of Authorized Signers (required) Workers’ Compensation Insurance Carrier WC Policy # (required) WC Expiration Date: MM JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YYYY 2023 2024 2025 2026 2027 2028 2029 2030 WC Contact Person (required) WC Contact Phone # (required) I understand that automatic or electronic payment of monthly fees will be required. (required) - Yes No # of Entry-Level Dairy Employees Needed (required) Preferred Date of Need JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER - 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2023 2024 2025 2026 2027 2028 2029 2030 Can Offer Competitive Work Hours (required) - Yes No How Many Hours of Work Per Week (required) Competitive Hourly Wage (required) Milking Shift for New Employees (required) # of Milking Groups (required) # of Cows Milked per Day (required) Milking Frequency (required) Average Lbs per Cow per Day (required) Somatic Cell Count (required) Milking Parlor Type (required) - Herringbone Parallel Tie-stall Other # of Milking Units per Side (required) Milking System Make & Model (required) Floor Scraping System (required) - Alley scraper Skidsteer Tractor Other Fore-strip Teats (required) - Yes No Wiping Material (required) - Paper Cloth Milkers Inject Cows (required) - Yes No Treated Cows Mixed in Various Groups (required) - Yes No, mixed in groups Milkers Chase Groups (required) Yes No, others chase Pre and Post Dip Same Solution (required) - Yes No ID System (please describe identification system for treated cows, e.g. red band means treated cow) (required) Distance from Worksite (required) - On-site Other Heat, Electricity, Clean Water (required) - Yes No Smoke Detectors in All Bedrooms (required) - Yes No Carbon Monoxide Detector (1 Central) (required) - Yes No First Aid Kit (required) - Yes No 2:A Fire Extinguisher (required) - Yes No Telephone for 911 Emergency (required) - Yes No Stove & Refrigerator (required) - Yes No Dishes, Glasses, Cooking Utensils (required) - Yes No Vacuum Cleaner, Broom, Cleaning Tools (required) - Yes No Kitchen Table & Chairs (required) - Yes No Dressers, Beds w/Linens & Blankets, Bath Towels (required) - Yes No Living Room Couch or Chair (required) - Yes No High Speed Internet (required) - Yes No Veterinarian or Breeder name (required) Relationship Phone # (required) Reference 2 name (required) Relationship Phone # (required) Reference 3 name (required) Relationship Phone # (required) Please provide other information that could help us identify and train prospective employee(s) I hereby consent to the processing of the data that I have provided to respond to my request. Send Downloads Download pdf Other Request non-dairy employees TN Visa employees
