Employment Application

Personal Information

Last Name:

First Name:

Middle Name:

Street address:

City:

State:

Phone:

Education High School or GED

Name and Location

Starting Date

Date Graduated

Subjects Studied

College

Name and Location

Starting Date

Date Graduated

Subjects Studied

Vocational

Name and Location

Starting Date

Date Graduated

Subjects Studied

Special Training

Name and Location

Starting Date

Date Graduated

Subjects Studied

General

US Military Service

Rank

Present membership in National Guard/Reserves?

Do you smoke?

If you are active in any organizations, list them here

Do you have any physical impairments that would prevent you from doing this work? (specify)

Height

Weight

Are you over age 21? You must be 21 or over to apply.

Are you over age 25?

Do you have a criminal record?

If so, for what?

Do you have a current South Dakota Driver's License?

Do you have a CDL?

Do you have any endorsements?

Have you had a DUI or alcohol-related traffic offense in the last three years?

Do you have any forklift experience?

Do you have a forklift license?

Employment You must list at least two jobs.
List your most recent job first.

Company Name & Address

Position

Starting Date

End Date

Reason for leaving

Job duties - be specific

Starting wage

Ending wage

Company Name & Address

Position

Starting Date

End Date

Reason for leaving

Job duties - be specific

Starting wage

Ending wage

Company Name & Address

Position

Starting Date

End Date

Reason for leaving

Job duties - be specific

Starting wage

Ending wage

Company Name & Address

Position

Starting Date

End Date

Reason for leaving

Job duties - be specific

Starting wage

Ending wage

Company Name & Address

Position

Starting Date

End Date

Reason for leaving

Job duties - be specific

Starting wage

Ending wage

Explain why we should consider hiring you

By submitting this form, I hereby state that all the information listed above is true and accurate. I understand, that if hired, any errors, misstatements or omissions on this application will be grounds for immediate dismissal.