Detasseling Application – Gangwish Seed Farms

Date

Legal Name

Your name must match what is on your social security card.

Legal First Name Legal Last Name

Date of Birth*

Age*

Must be 13 before date of hire

Please enter a number from 11 to 99.

Address*

Physical Address P.O. Box / Apt. # City State ZIP Code

Name of the school you attend*

Chose which town you will load the bus from*

If you don't go to one of the schools listed above please let us know which town you will be picked up from.

Home Phone*

Cell Phone*

Cell Phone Text Messaging Available?*

Yes
No

Parent/Guardian Cell Phone*

Parent/Guardian Cell Phone Text Messaging Available?*

Yes
No

Applicant Email*

Please only list an email that you check regularly. If don't have one, put your parent's email address here.

Enter Email Confirm Email

Enter Parent/Guardian email*

Enter Email Confirm Email

Have you Detasseled for GSF before?*

Yes
No
No, but have worked for another detasseling company

How many years?

Please enter a number less than or equal to 99.

Do you have any medical issues such as asthma, allergies, etc. or special medication?*

Yes
No

Please list your medical conditions or special medications.

Applicant Signature

The above person is my child/ward. All the above information in correct and I consent to be employed in agriculture (detasseling corn). Parent must sign if child is 12-14 years of age.

Parent/Guardian Signature

Name of school you attend (old - hidden field)

Social Security Number (old - hidden field)

Choose your crew based on your home town: (old - hidden field)

Shelton/Wood River - Cindy Brandt
Gibbon - Leon Stall
Ravenna/Pleasanton/Litchfield - Mark & Heather Hudson - 308-224-0651