EMPLOYEE APPLICATION

NEAREST / PREFERABLE CONSULATE:

Please List:_____________________

PERSONAL INFORMATION:
Nick Name: Last Name (Surname): First Name: Middle Name:
      Vazquez Delgado Juan      
Date of Birth: Age: Place of Birth:
21-07-1973 42 villachuato Michoacan

Nationality: Social Security Number: Identification Number: Passport Number:

(If applicable)
Mexican       VZDLJN73072116H900 G16555326
Passport issued: Valid until: Place of Issuance: Province:
(mm/dd/yy) (mm/dd/yy)
11-03-2015 11-03-2018 Michoacan Morelia
Have you ever applied If yes, What type of Visa? Where? Date:
for a visa in the USA?
     
Yes No            
Have you ever been When? Stipulate Reason. Have you ever worked in If yes, when?
denies a visa?       the USA?
     
Yes No Yes No
RELATED INFORMATION:
Do You Smoke? Yes No Do you consume alcohol? Yes No
If yes, How many a day?      
How many a day do you smoke?       How many a week?      
Have you ever used drugs? Yes No Have you ever been charged with driving intoxicated in the
last two years?
Yes No
Do you have any Criminal Offenses? Yes No
If yes, explain:      
Have you had any traffic violations in the past 2 years? Yes No
If yes, explain:      
FAMILY INFORMATION: Please provide contact information in case of an emergency.
Marital Status:
Married: Single: Divorced: Separated:
If married, Wife’s name and Wife’s Telephone Number: Address:
maiden name: Alma rosa       C. 20 de Noviembre
Rodriguez Wife’s Mobile (Cell) Number: Loc. Villachuato 58530
Name: Alma       Puruandiro Mich.
Maiden Name: Rosa
Both Parents Names: Parents Telephone Number: Address:
      C. 20 de Noviembr
Father: Juan Vazquez Parents Mobile (Cell) Number:
Mother: Maria DE L luz Delgado       Loc. Villachuato 58530 Puruandiro Mich

I, Juan Vazquez Delgado hereby declare that the above information is correct.

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 RESUME
PERSONAL INFORMATION:
First Name: Middle Name: Last Name (Surname):
Juan       Vazquez Delgado
Current Address: P.O. Box (if applicable):
C. 20 de Noviembre      

Loc. Villachuato 58530

Puruandiro Mich

Daytime Phone: Mobile Phone:

438-103-8081 4381038081
Fax Number: E-mail Address:
           
Date of Birth: Age: Place of Birth:
21-07-1973 42 Villachuato Michoacan
DRIVERS LICENSE CODE: (PLEASE CHECK)
Code 8 Code 10 Code 14 CDL
CDL License number (if any):       Expiration Date:      
EDUCATION:
High School Name: Grade Completed: 3 Grade
escuela primaria guadalupe victoria Year Obtained: 3 Grade
College/University (if any): Degree:      
      Year Obtained:      
LANGUAGE SKILLS:
English Speaking and Listening:
Excellent Good Fair Poor
English Reading and Writing:
Excellent Good Fair Poor
EMPLOYEMENT INTERESTS:
Please select all job categories you are interested in. Please remember the more you select the better chance you have
of getting a job offer. Certain categories are season and depends on season you are in. Check all that apply.

Grain Harvesting Cattle

Cotton Harvesting General Farming
Silage Harvesting Mechanic
Crop Farming Mills
Semi- Driver Fencing
Pecan Milking Parlor
Mink Farms Irrigation
Hog Farm Seed Company
Bee Keeper Other

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 EMPLOYEMENT HISTORY:
APPLICANT NAME: Juan Vazquez Delgado
Employer 1
Company Name: farmer
Address: Villachuato MIch
Country where company is located: Mexico
Phone:      
Supervisor Name:      
Job Title: farmer
Reason for Leaving: It is my only job
Dates of Employment: From: 1992 To: 2015
Job Description/Responsibilities: Planting corn, wheat , sorghum , strawberry including as fertilize, spray for
pests of crops     
Employer 2 (if any)
Company Name:      
Address:      
Country where company is located:      
Phone:      
Supervisor Name:      
Job Title:      
Reason for Leaving:      
Dates of Employment: From:       To:      
Job Description/Responsibilities:      

ABOUT MYSELF:
Please tell us about yourself, any farming or other related experience. Please also include any information you might
think is relevant to the position you are applying for:

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Hello my name Juan Vazquez Delgado I am in the need of going to the United States of America Because where i am
living now i have no job.. I am able to do any kind of work. , and also any kind of work that relates farms. was working on
the tractor Other agricultural implements

Juan Vazquez Delgado

REFERENCES:
APPLICANT NAME: Juan Vazquez Delgado
Please provide the name and phone number of two professional references who are not related to you. This may or may
not include previous employers. There are the names of people you want the employer to contact if they so desire.
Name: Manuel Vazquez Phone:      

Name: Gerardo Rodriguez Phone: USA (401) 706 1971

HEALT DECLARATION:
To be completed by ALL applicants together with your applicant profile.

Weight (lbs) 116.8

Height (ft & in) 3"60

Are you currently suffering from or have ever suffered from any of the following illnesses / disorders? Place an X in the appropriate
box.

YES NO

Any disorder of the Heart?

High blood pressure or disease of the blood vessels or circulatory disorder?

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Any respiratory or lung trouble?

Any disorder of the digestive system, gall bladder or liver?

Any nervous or mental complaint, e.g. epilepsy, blackouts, paralysis?

Any anxiety or depression?

Diabetes

Any physical abnormality, deformity, handicap, or defect?

Any form of severe allergy, such as asthma, sinusitis, hay-fever, etc.

Consulted a doctor for any reason in the last year?

Are you on any form of medication?

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 Checklist: Skills and Abilities
APPLICANT NAME: Juan Vazquez Delgado
FIELD EQUIPMENT: No Some Good
Skid Steer Loader
Large Field Tractor
4-WD Tractor
Articulating Tractor
Air Drill Planter / Seeder
ATV 4 Wheeler with spot
Sprayer
Chisel Plow
Chore Tractor
Combine, small
Combine 25 foot head flex
Combine 25 foot head straight
Combine 30 foot head flex
Combine 30 foot head straight
Combine 42 foot head flex
Combine 42 foot head straight
Cultivator
Planter
Spreader
Swath / Swather
Sickle mower
Rotary mower
Land roller
Harrow – 50 foot heavy harrow
Hay baler
Forage Chopper
Tandem
Grain Cart
Moldboard plow
Stone picker
Row crop cultivator
Row crop planter
Track driven tractor (like CAT)
Wheel Rake
Windrower – 25 foot – pull type

CROP RELATED SKILLS: No Some Good

Crop Spraying knowledge
Computerized instrument panel
Calibrate Sprayers
Driving self propelled cropsprayer
Planting operations & procedures
Tilling Operations

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 APPLICANT NAME:Juan Vazquez Delgado

FORAGE EQUIPMENT: No Some Good

Forage Chopper
Forage Preservation
Drive a pickup
Drive any size car
Drive a ¼ ton vehicle
Drive a ½ ton vehicle
Drive a 1 ton vehicle
Drive a 2.5 ton vehicle
Drive a semi truck & trailer
Drive a semi truck with two
trailers
Mower / conditioner
Round baler – big
Silage blower
Silage wagon
Square baler
Stack maker
Square bale - big

DAIRY SKILLS : No Some Good

Parlor milking
Milk in stall barns
Parlor Practice
Changing clusters
Take sterile samples
Diagnose and treat mastitis
Artificial Insemination
Vaccinations
Clipping / Torch udder
Stanchions

LIVESTOCK SKILLS(Cattle): No Some Good

Artificial Insemination
Vaccination
Castration – band method
Castration remove / cut method
Dehorning
Experience – Calf Jack /Breach
Deliver normal calf
Feeding cows and calves
De-worming
Hoof trimming
Detect ketosis
Detect milk fever
Detect twisted stomach (DA)
Diagnose / treat scours
Use of a balling gun
Dry cow feed program
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 APPLICANT NAME:Juan Vazquez Delgado
LIVESTOCK SKILLS (Hogs / Breeding): No Some Good
Artificial Insemination
Vaccination
Castration – band method
Castration remove / cut method
Feeding
Power washing
Pregnancy / Gestation checking
Record keeping (Heard)
Weaning
Heat synchronization
Implant embryo
Select mating for cows
Maintain daily logs
Herd health records
Read DHIA reports
Read pedigree
Understand ration printout
LIVESTOCK SKILLS (Feeding Equipment): No Some Good
Operate & Service Conveyor
Service top silo un-loader
Calibrate mix-mill
Automatic feed bunk
Computer feeder
Electronic scales
Grinder mixer
Run TMR mixer
MECHANICAL SKILLS: No Some Good
Maintenance combine
Maintenance 4-WD tractors
Maintenance large field tractors
Maintenance pickups
Maintenance track driven tractors
Overhaul diesel engines
Overhaul gas engines
Repair 4-WD tractors
Repair Chore tractors
Repair Combine
Repair Diesel/Gas/tractor engines
OTHER SKILLS: No Some Good
Fencing
Welding
Arc/ Gas/ Plasma Welding
Electrician
Operate a fork lift
Irrigation: Pivot/ Flood/
Sprinklers/ Micro

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APPLICANT NAME: Juan Vazquez Delgado DATE: 21-08-
2015
ADDITIONAL INFORMATION:
APPLICANT NAME: Juan Vazquez Delgado
If you are interested to apply, make sure that you send the following documentation to go with this document.

1. A color Photo
2. This completed Employee Application, Resume, checklist, and health declaration form.
3. A Signed declaration of payment terms (will be given to you by the agent)
4. Copy of your High school diploma and other diplomas that might be relevant
5. Copy of your Passport, ID document, and Drivers License (Mexico / CDL)
6. International Driver's License. This can be given after the consulate appointment.
7. Proof of deposit made for fees to US Consulate as agreed upon.

Drug Testing:

I understand that all prospective employees/current employees can be submitted to a controlled substance test. A urine
specimen will be collected at a site selected by the Company and tested for controlled substances at a certified
laboratory. I understand that if I decline to sign this consent and thereby decline to take the test or fail the test when
taken, employment will be terminated immediately and employee will be send back to Mexico at their own expense. If
selected to be tested for a controlled substance and the test is verified as positive, I will be considered unqualified for
employment and the company will have the right to terminate my employment. By typing/signing your name in the box
below you agree that you have read these terms and you are willing to be tested before or during employment, upon the
request of the company.

Alcohol Abuse:

Alcohol abuse will not be tolerated on the job or if it influences your ability on the job. The laws in the United States are
very strict when it comes to alcohol related crimes. It is illegal to drink if you are under the legal drinking age. The legal
drinking age in the United State is 21. If you buy for a minor or if you drink as a minor it is considered against the law and
could result in fines and in some cases jail time. If you receive a DUI (driving under the influence, you license will be
taken away and in some cases you could receive some jail time. This will be considered as grounds for termination. All
the jobs offered need a valid license, if you lose your license you will not be able to complete the job. If you abuse alcohol
and it interferes with your job, your employer has the right to terminate your employment and send you back to Mexico at
your own expense. If you violate this, the agent will not help you in finding a different job, you will have to go back to
Mexico. Please be responsible! By typing/ signing your name in the box below you agree that you have read these terms
and you agree to them.

I do agree that everything I have submitted in this document to its entirety is truthful. Golden Opportunities and its agents
cannot be held responsible if the information you submitted is incorrect or false. Please make sure that all the information
you have provided is correct. By typing/signing your name below, you agree that your information is correct and that you
will solely be held responsible for any false information.

Name: Juan Vazquez Delgado

Date: 21-08-2015