Rapid City, SD Office: 605-791-4748 | Gillette, WY Office: 307-363-4278

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Home
About us
Services
Employment
Blog
Contact

Rapid City, SD Office: 605-791-4748

Gillette, WY Office: 307-363-4278

CALL NOW

City Desk Position Application

Applicant Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home Phone(Required)

Cell Phone(Required)

Email(Required)

Driver's License Number(Required)

State Issued(Required)

Expiration Date(Required)

Restrictions(Required)

Social Security Number(Required)

Date of Birth(Required)

Marital Status(Required)

Single

Married

Divorced

Widowed

In Case of Emergency Contact(Required)

Relationship to You(Required)

Phone Number(Required)

Do you have a reliable mode of transportation?(Required)

Yes

Are you legally authorized to work in the U.S.?(Required)

Yes

Have you ever served in the U.S. Military?(Required)

Yes

Have you ever been convicted of a felony?(Required)

Yes

Have you ever claimed or received workman's compensation for any injuries incurred on the job?(Required)

Yes

If yes, please specify the name of the employer, dates in which you received compensation, and nature of injuries incurred.

Education

Please select highest grade completed.(Required)

Highschool Name

City/State

Degree Earned

College Name

City/State

Degree Earned

Other

City/State

Degree Earned

Previous Employment

Please start with your most recent employer.

Company Name(Required)

City/State(Required)

Phone Number(Required)

Dates Employed(Required)

Starting and ending dates.

Supervisor's Name(Required)

Supervisor's Phone Number(Required)

Job Title(Required)

Pay $(Required)

Hourly or Annually?(Required)

Duties Included(Required)

Reason for Leaving(Required)

Are you currently working for this employer?(Required)

Yes

May we contact the supervisor listed for a reference?(Required)

Yes

Company Name(Required)

City/State(Required)

Phone Number(Required)

Dates Employed(Required)

Starting and ending dates.

Supervisor's Name(Required)

Supervisor's Phone Number(Required)

Job Title(Required)

Pay $(Required)

Hourly or Annually?(Required)

Duties Included(Required)

Reason for Leaving(Required)

Are you currently working for this employer?(Required)

Yes

May we contact the supervisor listed for a reference?(Required)

Yes

Company Name(Required)

City/State(Required)

Phone Number(Required)

Dates Employed(Required)

Starting and ending dates.

Supervisor's Name(Required)

Supervisor's Phone Number(Required)

Job Title(Required)

Pay $(Required)

Hourly or Annually?(Required)

Duties Included(Required)

Reason for Leaving(Required)

Are you currently working for this employer?(Required)

Yes

May we contact the supervisor listed for a reference?(Required)

Yes

References

Please list references other than family members.

Name(Required)

First

Phone(Required)

Years Known(Required)

Relationship(Required)

Name(Required)

First

Phone(Required)

Years Known(Required)

Relationship(Required)

Name(Required)

First

Phone(Required)

Years Known(Required)

Relationship(Required)

Authorization(Required)

I agree.

I authorize all persons, schools, companies, and current and/or former employers to release any information concerning my background, and hereby release any said persons, schools, companies, and current and/or former employers from any liability for any damage whatsoever for issuing this information.

Disclaimer & Signature(Required)

I agree.

I certify that the answers given by me to the foregoing questions and any statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions, or misrepresentations of facts regarding information called for in this application may result in rejection of my application, or discharge at any time during employment. I understand that if I am hired, my employment shall be "at-will", and that either I or the company can choose to terminate the employment relationship for any reason, or no reason at all, with or without notice.

Signature(Required)

First Last

Date(Required)

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Max. file size: 128 MB.

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