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Application for Employment

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We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital status, the presence of a non-job-related condition or handicap, or any other legally protected status.
Name*
Address

ELIGIBILITY

If you are under 18 years of age, can you provide proof of your eligibility to work?
Have you ever filed an application with us before?
MM slash DD slash YYYY
Have you ever been emplyed by us before?
MM slash DD slash YYYY
Are you prevented from lawfully becoming employed in this country because of VISA or Immigration Status?
Can you provide proof of citizensip or immigration status?
Are you physically or otherwise unable to perform any of the duties of the job for which you are applying?
Have you ever been convicted of a felony within the last 7 years?
Conviction will not necessarily disqualify an applicant from employment.

DRIVER APPLICANTS ONLY

Do you currently have a Commercial Drivers License (CDL)?
Are you willing to test for a Commercial Drivers License (CDL)?
Do you currently have a Hazmat Endorsement?

AVAILABILITY

MM slash DD slash YYYY
Are you available to work
Are you currently on "lay off" satus and subject to recall?
Can you travel if a job requires it?

EMPLOYMENT EXPERIENCE

Start with your present or last job, include any related military service assignments and volunteer activities. you may exclude organizations which indicate race, color, religion, gender, national origin, handicap or other protected status.
MM slash DD slash YYYY
Current Employer?*
MM slash DD slash YYYY
May we contact this employer?*

MM slash DD slash YYYY
MM slash DD slash YYYY
May we contact this employer?*

MM slash DD slash YYYY
MM slash DD slash YYYY
May we contact this employer?*

MM slash DD slash YYYY
MM slash DD slash YYYY
May we contact this employer?*

Special Skills and Qualifications
Summarize any special job-related skills and qualifications from employment or other experience.

EDUCATION

Did you graduate high school?
List professional, trade, business or civic activities and offices held:
You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, handicap or other protected status.

REFERENCES

Give three (3) references who are not related to you and are not your previous employers.
This field is hidden when viewing the form
Untitled*
Please only contact these references:*
Applicant's Statement*
I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving to an employment decision. This application for employment shall be considered active for a period not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. The applicant understands that neither this document nor any offer of employment from the employer constitute an employment contract unless a specific document to that affect is executed by the employer and employee in writing. in the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all the rules and regulations of the employer.
Clear Signature

Hot Springs – HQ

1346 Galveston Avenue
Hot Springs, SD 57747
605-745-4189

Edgemont

109 2nd Street
Edgemont, SD 57735
605-662-7500

Custer

831 Mt Rushmore Road
Custer, SD 57730
605-673-4371

Hill City

23909 Hwy 385
Hill City, SD 57745
605-574-4303

Hermosa

720 W Main Street
Hermosa, SD 57744
605-255-4544

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