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Chamberlain

South Dakota

~ Official Website

City Job Application Form

Birthday
Month
Day
Year
Can you perform the essential functions of the position for which you are applying?
Yes
No
Are you legally eligible to be employed in the United States?
Yes
No

(Proof of identity and eligibility will be required upon employment)

Are you over the age of 18 years?
Yes
No

(If no, you may be required to provide authorization to work.)

Have you ever been convicted of a felony or a misdemeanor which resulted in imprisonment within the last seven years?
Yes
No

(A conviction will not necessarily result in the denial of employment.)

Have you ever worked for the City before?
Yes
No
Do you have any relatives or friends who work for the City?
Yes
No
Have you ever done any volunteer work?
Yes
No

(Omit any information that reflects your race, color, religion, age, sex, sexual orientation, marital status or disabilities)

When are you available to work:
Are you presently employed?
Yes
No
If yes, may we contact your employer?
Yes
No

Put N/A if not presently employed.

Do you belong to any profession, trade, business or civic organizations that deal with the position for which you are applying?
Yes
No

(Omit any organization which reflects your race, color, religion, age, sex, sexual orientation, marital status or disabilities.)

Please put the month, year and reason.

Education

Put N/A if not attended

Name

Did you graduate:
Yes
No

Name

Did you graduate:
Yes
No

Name

Did you graduate:
Yes
No
Have you completed any special courses, seminars and/or training that would enable you to perform the position for which you are applying?
Yes
No

(Omit any which reflects your race, color, religion, age, sex, sexual orientation, marital status or disabilities.)

Employment

Start with your present or most recent position

Multi-line address
Multi-line address
Multi-line address

Personal References

Multi-line address
Multi-line address
Multi-line address
APPLICANTS WILL RECEIVE CONSIDERATION FOR POSITIONS, WITHOUT REGARD TO RACE, COLOR, RELIGION, AGE, SEX, EXCEPT WHERE SEX IS A BONAFIDE OCCUPATIONAL QUALIFICATION, SEXUAL ORIENTATION, MARITAL STATUS, INDIVIDUALS WITH DISABILITIES, AND EQUALLY TO DISABLED VETERANS AND VETERANS OF THE VIETNAM ERA.

Add your text

IMPORTANT, PLEASE READ AND SIGN

I understand that failure to reveal any prior employer, or giving false or misleading information by me on any part of this Application for Employment can be grounds for termination from the company or its subsidiaries. I understand that if I am hired, my employment is for no definite time and may be terminated at any time without prior notice.

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