Detasseling Application – Gangwish Seed Farms

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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*

Gibbon Public Schools
Litchfield Public Schools
Pleasanton Public Schools
Ravenna Public Schools
Shelton Public Schools
Wood River Rural Schools

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.

Gibbon, NE
Litchfield, NE
Pleasanton, NE
Ravenna, NE
Shelton, NE
Wood River, NE

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

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Name of school you attend (old - hidden field)

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Social Security Number (old - hidden field)

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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