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Information Request Form

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Portage North | Portage Central |

Detasseling Information Request Form

This Information Request is not an offer of employment. An offer of employment, if made at all, will be made at a later time.

We hire all of our employees from the Portage North, Portage Central, area(s). If you are not from the above area(s) you should not fill out this request form.

Name:

Address:

City:

State:

Zip:

Age:

Birthdate:

Phone:

E-mail:

School:

Have You Detasseled Before:

If you Answered Yes Above, How Many Years?: