Fillable APPLICATION FOR EMPLOYMENT JSND/WORKFORCE PROGRAMS

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APPLICATION FOR EMPLOYMENT JSND/WORKFORCE PROGRAMS

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The APPLICATION FOR EMPLOYMENT JSND/WORKFORCE PROGRAMS form is 3 pages long and contains:

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  • 37 check-boxes
  • 142 other fields

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File type: PDF

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Company Applying To________________________________________________________________________________
Position Title or Job Order #___________________________________________________________________________
GENERAL INFORMATION
Name (Last)
(First)
(Middle Initial)
Home Telephone
( ) -
Address (Mailing Address)
(City)
(State)
(Zip)
Other Telephone
( ) -
E-Mail Address
Date You Can Start Work
Days Available: Sunday Monday Tuesday
Wednesday Thursday Friday Saturday
Will Accept:
Part-Time
Full-Time
Temporary
Regular
Shift:
Day
Swing/Evening
Graveyard/Night
Rotating
Split
Are you able to perform the essential functions of the job you are applying for,
with or without reasonable accommodation? Yes No
DRIVER LICENSE INFORMATION
Do you have a valid driver license? Yes No Driver License Class____________ Issuing State_______
Endorsements (check all that apply): Tanker Vehicles Double & Triple Trailers Hazardous Materials
School Bus Passenger Bus
EDUCATION, TRAINING, CERTIFICATIONS AND VETERAN STATUS
Do you have a High School Diploma? Yes No Do you have a GED? Yes No
Other education after High School (most recent first):
Name of School, City, State
# of Quarter
or Semester
Credits
Earned
Graduated
Earned Degree
AA, AS, AAS,
BA, BS,
Masters, PhD
Major or
Course of Study
Yes
No
Yes
No
Occupational License, Certificate or Registration
Number
Issued By
Expiration Date
Occupational License, Certificate or Registration
Number
Issued By
Expiration Date
Are you a U.S. Military Veteran? Yes No
ADDITIONAL INFORMATION AND SKILLS
Describe volunteer work, community involvement, hobbies, or other qualification or skills:
APPLICATION FOR EMPLOYMENT
JSND/WORKFORCE PROGRAMS
SFN 16770 (R. 3-14)
Name _____________________________________ Page 2
WORK EXPERIENCE (Current or most recent first)
Employer
Telephone Number
From (Month/Year)
Street Address/City/State
Job Title
To (Month/Year)
Duties/Skills/Equipment and Software Used:
Hours Per Week
Last Salary
Last Supervisor
Reason For Leaving
May We Contact This Employer? Yes No
Employer
Telephone Number
From (Month/Year)
Street Address/City/State
Job Title
To (Month/Year)
Duties/Skills/Equipment and Software Used:
Hours Per Week
Last Salary
Last Supervisor
Reason For Leaving
May We Contact This Employer? Yes No
Employer
Telephone Number
From (Month/Year)
Street Address/City/State
Job Title
To (Month/Year)
Duties/Skills/Equipment and Software Used:
Hours Per Week
Last Salary
Last Supervisor
Reason For Leaving
May We Contact This Employer? Yes No
BUSINESS-RELATED REFERENCES
Name
Address, City, State, Zip
Phone Number
I certify the information contained in this application is true, correct, and complete.
I understand that if I become employed, false statements reported on this application may be considered sufficient
cause for dismissal.
Applicant Signature: _______________________________________________ Date: ____________________________
As employers, the State of North Dakota and political subdivisions prohibit smoking in all places of state and political subdivision employment in accordance with N.D.C.C. § 23-12-10
Job Service North Dakota is an equal opportunity employer/program provider.
Auxiliary aids and services are available upon request to persons with disabilities.
click to sign
signature
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Name _____________________________________ Page 3
WORK EXPERIENCE (Current or most recent first)
Employer
Telephone Number
From (Month/Year)
Street Address/City/State
Job Title
To (Month/Year)
Duties/Skills/Equipment and Software Used:
Hours Per Week
Last Salary
Last Supervisor
Reason For Leaving
May We Contact This Employer? Yes No
Employer
Telephone Number
From (Month/Year)
Street Address/City/State
Job Title
To (Month/Year)
Duties/Skills/Equipment and Software Used:
Hours Per Week
Last Salary
Last Supervisor
Reason For Leaving
May We Contact This Employer? Yes No
Employer
Telephone Number
From (Month/Year)
Street Address/City/State
Job Title
To (Month/Year)
Duties/Skills/Equipment and Software Used:
Hours Per Week
Last Salary
Last Supervisor
Reason For Leaving
May We Contact This Employer? Yes No
Employer
Telephone Number
From (Month/Year)
Street Address/City/State
Job Title
To (Month/Year)
Duties/Skills/Equipment and Software Used:
Hours Per Week
Last Salary
Last Supervisor
Reason For Leaving
May We Contact This Employer? Yes No
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APPLICATION FOR EMPLOYMENT JSNDWORKFORCE PROGRAMS

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Completed 17 September 2021

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