Applications are now open Applications Form: 1. PHOTO AND VIDEOPhoto of Applicant *Choose FileNo file chosenDelete uploaded fileIntroductory video (1-3 min) Please upload a 1-3 minute video of yourself demonstrating your skills on farm implements or trucks via WeTransfer (https://wetransfer.com/). Applications without a video will not be considered. Upload your video and send it to: exclusiveplacementsusa@gmail.com. 2. PERSONAL INFORMATIONFirst Name *Middle NameLast Name *Current Address *P.O. Box (If applicable)Whatsapp phone number *Work phone *Mobile Phone *Email Address *Marital Status *Age *Gender *Name of Emergency Contact *Relationship *Phone Number *English Speaking and Listening *ExcellentGoodFairPoorEnglish Reading and Writing *ExcellentGoodFairPoorSmoking/Vaping *NeverOccasionalModerateHeavyAlcohol Use *NeverOccasionalModerateHeavyDo you have any health problems? (Allergies, Disabilities, Serious/Chronic Medical Conditions) *YesNoIf Yes, provide details: *Have you been charged with any traffic violations or driving while intoxicated in the last two years? *YesNoIf Yes, to the above question, please explain the violation. *Do you have any criminal offenses? *YesNoIf Yes, to the above question, please explain the offence. *South African Driver's License: Guide to South African Driver's License CodesCode A (Motorcycles)Code B (Light Motor Vehicles - weight less than 3500kg with/without trailer up to 750kg)Code EB (Light Motor Vehicles - weight less than 3500kg with/without trailer more than 750kg)Code C1 (Vehicles with wieght between 3500kg - 16000kg with/without trailer up to 750kg)Code C (Buses and goods vehicles with weight more than 16000kg with/without trailer up to 750kg)Please upload copy of Code C1 License (JPG, PNG or PDF) *Choose FileNo file chosenDelete uploaded filePlease upload copy of Code C License (JPG, PNG or PDF) *Choose FileNo file chosenDelete uploaded fileLearner's License (If any)If you have been in the USA before, provide most recent license information:CDL LicenseYesCountry issued *License expiry date: *Do you have a Social Security Number (obtained in the USA)?YesNo3. CURRENT OR LAST SA / USA EMPLOYERRecent Employer's Name: *Recent Employer's Location: *Contact Details: *VISA Date Issued:VISA Expiry Date:USA Arrival Date:USA Departure Date:VISA Type:VISA Number:4. SKILLS SUMMARYPlease select your experience / competency in years in each area. SKILL COMPETENCYNone | 1 Year or less | 2 Years | 3 Years | 4 Years | 5 Years + SAUSAPutting up fencesPutting up fences SA012345Putting up fences USA012345FeedlotsFeedlots SA012345Feedlots USA012345Operating CultivatorOperating Cultivator SA012345Operating Cultivator USA012345Operating TillerOperating Tiller SA012345Operating Tiller USA012345Operating PlanterOperating Planter SA012345Operating Planter USA012345Operating SprayerOperating Sprayer SA012345Operating Sprayer USA012345Operating Forage / Silage ChoppingOperating Forage / Silage Chopping SA012345Operating Forage / Silage Chopping USA012345Operating Silage BlowerOperating Silage Blower SA012345Operating Silage Blower USA012345Operating BalerOperating Baler SA012345Operating Baler USA012345Operating Swather / WindrowerOperating Swather / Windrower SA012345Operating Swather / Windrower USA012345Operating CombineOperating Combine SA012345Operating Combine USA012345Operating Grain CartOperating Grain Cart SA012345Operating Grain Cart USA012345Operating GPS Farm EquipmentOperating GPS Farm Equipment SA012345Operating GPS Farm Equipment USA012345Operating Manure Spreading EquipmentOperating Manure Spreading Equipment SA012345Operating Manure Spreading Equipment USA012345Operating Other Heavy MachineryOperating Other Heavy Machinery SA012345Operating Other Heavy Machinery USA012345Operating TractorOperating Tractor SA012345Operating Tractor USA012345Truck driving related to harvestingTruck driving related to harvesting SA012345Truck driving related to harvesting USA012345Truck driving non-agriculturalTruck driving non-agricultural SA012345Truck driving non-agricultural USA012345Mechanical WorkMechanical Work SA012345Mechanical Work USA012345WeldingWelding SA012345Welding USA012345Other SkillsOther Skills SA012345Other Skills USA0123455. EQUIPMENT EXPERIENCETractors (Max 3):Make / ModelApprox hrs of operation+Remove itemExplain how you have used this equipment. Also include any maintenance or trouble shooting experience that you have with the equipment.Truck Driving Experience:South African Driver's License: Guide to South African Truck Driver's License CodesCode EC1 (Articulated vehicles between 3500kg - 16000kg - Also rigid vehicles between 3500kg - 16000kg with trailer more than 750kg)Code EC (Articulated vehicles more than 16000kg - Also rigid vehicles more than 16000kg with trailer more than 750kg)Please upload copy of Code EC1 License (JPG, PNG or PDF) *Choose FileNo file chosenDelete uploaded filePlease upload copy of Code EC License (JPG, PNG or PDF) *Choose FileNo file chosenDelete uploaded fileTransmission Type:AutomaticManual - ClutchlessManual - ClutchSpeed:9 speed10 speed13 speed18 speedSpecify the type of trucks you have operated:Pick-up truckBox/Straight truckSemi-trailer truckTrucks (Max 3):Make / ModelApprox hrs of operation+Remove itemCombines / Choppers / Grain Carts or Other Harvesting Equipment (Max 3):Make / ModelApprox hrs of operation+Remove itemExplain how you have used this equipment. Also include any maintenance or trouble shooting experience that you have with the equipment.Planting / Tillage / Cultivation Equipment (Max 3):Make / ModelApprox hrs of operation+Remove itemExplain how you have used this equipment. Also include any maintenance or trouble shooting experience that you have with the equipment.Silage / Haymaking / Baling Equipment (Max 3):Make / ModelApprox hrs of operation+Remove itemExplain how you have used this equipment. Also include any maintenance or trouble shooting experience that you have with the equipment.Spraying Equipment (Max 3):Make / ModelApprox hrs of operation+Remove itemType of SprayingApprox hrs of operationExplain how you have used this equipment. Also include any maintenance or trouble shooting experience that you have with the equipment.Irrigation:Center PivotApprox hrs of operationPolypipeApprox hrs of operationExplain how you have used this equipment. Also include any maintenance or trouble shooting experience that you have with the equipment.Earth Moving Equipment / Other Heavy Machinery (Max 3):Make / ModelApprox hrs of operation+Remove itemExplain how you have used this equipment. Also include any maintenance or trouble shooting experience that you have with the equipment.Please explain in detail your truck driving (semi-truck) experience. Please mention the last time you operated the above-mentioned trucks. Also include any maintenance or trouble shooting experience that you have with trucks.6. FARMING EXPERIENCECrop Farming (Max 3):Please list the types of crop (corn, wheat, beans, sunflowers, potatoes, silage, etc.) you have experience with and the duties you have performed related to these crops.Types of Crop:Duties:Add itemRemove itemCotton Harvesting (Max 3):Please list the types of cotton you have experience with and the duties you have performed related to cotton harvesting.Types of Cotton:Duties:Add itemRemove itemGrain Harvesting (Max 3):Please list the types of grain you have experience with and the duties you have performed related to grain harvesting.Types of Grain:Duties:Add itemRemove itemCattle Farming (Max 3):Please list different types of breeds of cattle that you have worked with. Please list the duties you performed when working with cattle. Example: AI, vaccination, castration, calving, dehorning, etc.Breeds:Duties:Add itemRemove itemDairy Farming (Max 3):Please list the breeds you have experience with on the dairy farm as well as the duties you performed while working on the dairy farm.Breeds:Duties:Add itemRemove item7. MECHANICAL EXPERIENCEPlease upload copy of Diesel Mechanic Certificate (Red Seal or Other), if applicable. (JPG, PNG or PDF)Choose FileNo file chosenDelete uploaded fileDescribe your skills:Do you have any other skills? Describe (e.g. welding)8. ABOUT MYSELFWrite a brief description about yourself: *Declaration: *I agree that everything I have submitted in this document, in its entirety, is truthful. Exclusive Placements and its agents cannot be held responsible if any information I have submitted is incorrect or false. By typing/signing my name below, I agree that my information is correct and that I will be solely responsible for any false information. PLEASE NOTE: False statements are grounds for termination by employer and all fees payable back to farmer.Name: *Date: *Submit Application
