Employment Application

Name *
Name
Phone Number
Phone Number
Address *
Address
Date Available
Date Available
Are you a citizen of the United States? *
If no, are you authorized to work in the United States?
Have you ever worked for Meade County, South Dakota? *
Have you ever been convicted of a felony? *
Education
Last Year of School Completed
Did you graduate High School?
Last Year of College Completed
Did you graduate College?
Last Year of Other Schooling Completed
Did you graduate?
REFERENCES
Reference #1: Address
Reference #1: Address
Reference #1: Phone
Reference #1: Phone
Reference #2: Address
Reference #2: Address
Reference #2: Phone
Reference #2: Phone
Reference #3: Address
Reference #3: Address
Reference #3: Phone
Reference #3: Phone
Previous Employment
Most Recent Employer
Employer #1: Address
Employer #1: Address
Employer #1: Phone
Employer #1: Phone
Employer #1: Start Date
Employer #1: Start Date
Employer #1: End Date
Employer #1: End Date
May we contact your previous supervisor for references?
Employer #2: Address
Employer #2: Address
Employer #2: Phone
Employer #2: Phone
Employer #2: Start Date
Employer #2: Start Date
Employer #2: End Date
Employer #2: End Date
May we contact your previous supervisor for references?
Employer #3: Address
Employer #3: Address
Employer #3: Phone
Employer #3: Phone
Employer #3: Start Date
Employer #3: Start Date
Employer #3: End Date
Employer #3: End Date
May we contact your previous supervisor for references?
Military Service
Start Date
Start Date
End Date
End Date
Disclaimer and Electronic Signature
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Electronic Signature *
Electronic Signature
Please type in your full name.
Signature Date *
Signature Date
Voluntary Self-Identification
(Confidential: FOR STATISTICAL USE ONLY)

We are an equal opportunity employer and do not discriminate on the basis of race, color, religion, sex, national origin, disability, veteran status, sexual orientation, or any other classification protected by federal, state, or local law. The information below will be used only in the compilation of data for affirmative action reporting.

Completion of this data is voluntary and will not affect your opportunity for employment or terms or conditions of employment, if hired. Identification can be declared at any time prior to or, if applicable, after hire. Please return this page with your application.

PLEASE COMPLETE IN FULL:
Date
Date
Sex
Date of Birth
Date of Birth
Race/Ethnicity
Please check one of the descriptions below corresponding to the ethnic group with which you most identify.
Consent for Criminal Background Check
I authorize Meade County to conduct a criminal background check on myself. I release the following information to assist in the investigation.
Current Address *
Current Address
Date of Birth *
Date of Birth
Have you ever been convicted of a felony or misdemeanor?
Offense, date, place, etc.
I understand that a prior conviction will not necessarily disqualify me for employment. *
I understand that a prior conviction will not necessarily disqualify me for employment.
Electronic Signature (Please type in your full name)
Signature Date *
Signature Date