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Employment Application

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Fields marked with * are required

Name *

Present Address *

City *

State *

Zip *

Permanent Address

City

State

Zip

Phone *

Referred By

Position *

Date You Can Start *

Salary Desired *

Are You Employed Now *

Yes No

May We Contact Your Current Employer

Yes No

Are You Legally Authorized to Work in the US? *

Yes No

Ever Applied to this Company Before *

Yes No

Where/When

High School Name & Location

Years Attended

Did You Graduate?

Yes No

Subjects Studied

College Name & Location

Years Attended

Did You Graduate

Yes No

Subjects Studied

Trade, Business or Correspondence School Name & Location

Years Attended

Did You Graduate?

Yes No

Subjects of Special Study/Research Work

Special Training

Special Skills

US Military or Naval Service

Rank

Most Recent/Current Employer *

Employed From *

Employed To

Location *

Salary *

Position *

Reason for Leaving *

Previous Employer

Location

Employed From

Employed To

Salary

Position

Reason for Leaving

Previous Employer

Employed From

Employed To

Location

Salary

Position

Reason for Leaving

1. I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
2. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.
3. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.
4. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

Signature *

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All the
Wonders the
Black Hills
Has to offer!

Ramada

605-666-4917
115 Swanzey Street
Keystone, SD 57751
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