Employment Opportunities - Dakota Traffic Services

Name *

First

Last

Home & Cell #s

Address

Position Applying For

ANY PRIOR ASSOCIATION WITH DAKOTA TRAFFIC?

Have you ever interviewed with Dakota Traffic Services before?

Yes
No

If yes, list dates, job title, and location

Do you have any relatives who have been employed by Dakota Traffice Services before?

Yes
No

If yes, list dates, job title, and location (copy)

Section Divider

Are you at least 18 years of age?

Yes
No

If under the age of 18, do you have a work permit? (copy)

Yes
No

Highest institution of schooling attended?

List highest grade or number of years completed

List the name, address, area of study, and any degrees, diplomas, licenses, or certificates

List any Professional Designations

Computer Skills Hardware/Software Skills

If yes, WPM

Clerical applicants only: Do you type?

Yes
No

PREVIOUS EMPLOYMENT

List all employment for the last 10 years, starting with the most recent position. All information must be completed. You may attach a resume, but not in place of completing the required information.

MOST RECENT JOB

Employed From

Employer Name

Manager Name

Starting Wage

Employer Address

Manager Phone #

Ending Wage

Job Title

Reason For Leaving

Duties/Responsibilities

Employed From

Employer Name

Manager Name

Starting Wage

Employer Address

Manager Phone #

Ending Wage

Job Title

Reason For Leaving

Duties/Responsibilities

GENERAL WORK INFORMATION

May we contact your current employer for references?

Yes
No

If hired, will you be able to work overtime?

Will you be able to perform the essential job functions for the position you are applying for with or without accommodation?

Have you ever been convicted of a crime, excluding misdemeanors and summary offenses, which has not been annulled, expunged or seals by court? (A yes answer does not automatically disqualify your application).

Yes
No

For Insurance purposes, it is the policy of Dakota Traffic Services to check the driving record of applicants. May we contact the Department of Motor Vehicles and ask for this information?

Yes
No

CERTIFICATION & AUTHORIZATION

The above information is true and correct. I understand that, in the event of my employment by the Company, I shall be subject to dismissal if any information that I have given in this application is false or misleading or if I have failed to give any information herein requested, regardless of the time elapsed after discovery. I authorize the Company to inquire into my educational, professional and past employment history references as needed to research my qualifications for this position. I hereby give my consent to any former employer to provide employment-related information about me to the Company and will hold the Company and my former employer harmless from any claim made on the basis that such information about me was provided or that any employment decision was made on the basis of such information. I further authorize the Company to obtain any credit and consumer check. I understand that nothing in this employment application, the granting of an interview or my subsequent employment with the Company is intended to create an employment contract between myself and the Company under which my employment could be terminated only for cause. On the contrary, I understand and agree that, if hired, my employment will be terminable at will and may be terminated by me or the Company at any time and for any reason. I understand that no person has any authority to enter into any agreement contrary to the foregoing. If employed, I will be required to provide original documents which verify my identity and right to work in the United States under the Immigration Reform and Control Act (IRCA) of 1986. The document(s) provided will be used for completion of Form I-9. I hereby acknowledge that I have read and agree to the above statements.

Signature & Date: