Biringer Farm Picker Application - Age 18 and over Only

Pickers must be 18 years of age or older to apply using this form

* Required

First Name *	Last Name *
Email Address *	Date of Birth *
Home Address *
City *	State *
Zipcode/Postcode *	Country * -- Select Country -- UNITED STATES
Number of Years Lived at this Address *	Do you live Less than 25 miles away from the Farm? * -- Please select -- Yes No
Home Phone Number *
Number of Years worked for Biringer Farm? *	Previous Agriculture Experience? * -- Please select -- Yes No
Previous Employer Name *
Previous Type of Work *	Number of Years Employed *
Previous Employer *
Previous Type of Work *	Number of Years Employed *
Previous Employer *
Previous Type of Work *	Number of Years Employed *
Enter Word Verification in box below *

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