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16546 37TH ST SE, MAPLETON, ND 58059 · I-94 EXIT 340
(701) 532-0101
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ONLINE APPLICATION
Personal
Name
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Do you have the legal right to live and work in the U.S.?
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Other name(s) under which you have been previously employed
Names of friends or relatives employed in this organization
Have you ever applied to this organization before?
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No
If Yes, give date and position applied for
Do you have any family, business, health, or social restrictions or obligations that would prevent you from performing the job responsibilities?
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No
Do you have any physical or mental condition or handicap which would endanger the health or safety of yourself and or others or that may affect your ability to perform the job(s) for which you are applying?
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Yes
No
If yes, please describe such condition or handicap.
Have you ever been convicted of a felony?
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Yes
No
If yes, list dates, offenses, and disposition.
Convictions are not an automatic disqualification from employment.
Will you comply with the safety work and attendance policies of our organization?
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Yes
No
Employment Interests
Position(s) Desired or Area of Interest:
Date Available
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MM slash DD slash YYYY
How were you referred to our organization?
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Employee
Other Company
Agency
Self
Employment Service
Name of Referral Source:
Education/U.S. Military Service
Where did you attend high school & college? (Click the + button to add a new row)
*
School Name & Address
Major
Years Completed
GPA
Degree/Diploma
Are you taking any educational course(s) presently?
*
Yes
No
I will be soon
If Yes or you will be soon, what and where?
Have you ever served in the U.S. Armed Services?
Yes
No
US Military Duties and special training
Rank held at discharge
References
List 3-5 people we may contact who are qualified to evaluate your capabilities. Do not include relatives. (Click the + button to add a new row)
Name
Address
Occupation
Years Known
Employment History
Give employment record as completely as possible listing current or most recent employer first. Show unemployed or self-employed periods and indicate dates and comment on each period. Include part time or summer work.
Company Name (Most Recent)
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
Dates Employed
From
To
Job Title
Supervisors Name & Title
Type of Business
Business Website
Base Rate of Pay (Hour/Week/Month)
Start
End
Description of duties
Reason for Leaving?
May we contact this employer?
Yes
No
Did you have another job before this one?
*
Yes
No
Company Name (Second Most Recent)
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
Dates Employed
From
To
Job Title
Supervisors Name & Title
Type of Business
Business Website
Base Rate of Pay (Hour/Week/Month)
Start
End
Description of duties
Reason for Leaving?
May we contact this employer?
Yes
No
Would you like to list another previous job?
Yes
No
Company Name (Third Most Recent)
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
Dates Employed
From
To
Job Title
Supervisors Name & Title
Type of Business
Business Website
Base Rate of Pay (Hour/Week/Month)
Start
End
Description of duties
Reason for Leaving?
May we contact this employer?
Yes
No
Would you like to list a 4th job?
Yes
No
Company Name (Fourth Most Recent)
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
Dates Employed
From
To
Job Title
Supervisors Name & Title
Type of Business
Business Website
Base Rate of Pay (Hour/Week/Month)
Start
End
Description of duties
Reason for Leaving?
May we contact this employer?
Yes
No
I agree to a Drug Screening at the company's expense.
*
Yes
No
I agree to a Criminal Background Check at the company's expense.
*
Yes
No
Acknowledgement
Insert Your Legal Terms of Service Here
Digital Signature:
Printing your First Name + Middle Initial + Last Name will act as your digital signature.
Date
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Alignment
Quick Lube
Ag Wheels
Auto Crane
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About
Contact
Employment
Jobs
Online Application
16546 37TH ST SE, MAPLETON, ND 58059 · I-94 EXIT 340
(701) 532-0101
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