Employment - South Dakota Partners – Printed Circuit Board Assembly Services

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APPLICANT INFORMATION
Name*
First Middle Last
Address
Street Address Address Line 2 City State ZIP Code
Email*
Cell Phone
Home Phone
What is the best method to contact you?
What is the best time to contact you?
Are you authorized to work in the US?
Note: Proof of citizenship or immigration status will be required upon employment
- Yes
- No
Are you at least 18 years of age?
- Yes
- No
Consent: Background Check & Drug Screen
I understand a background check and pre-employment drug screen will be conducted upon employment
Check if you understand that if hired a background check and a pre-employment drug screen will be conducted.
Have you been convicted of a felony within the last 7 years?
Note: A yes answer will not prevent consideration for employment
- Yes
- No
If yes, please explain:
EMPLOYMENT INFORMATION
Position Applying For
Date Available to Start
MM slash DD slash YYYY
Desired Rate of Pay
Are you currently employed?
- Yes
- No
May we contact your present employer?
- Yes
- No
Based on the job description posted, are you capable of performing the essential functions of the job or position with or without reasonable accommodation?
- Yes
- No
EDUCATION & TRAINING
High School
High School Location
City State
Diploma?
- Yes
- No
- GED
College / University Vocational School
Name City & State Type of Degree Major Course of Study Degree Received?
Additional Qualifications
Summarize special job-related skills, certifications and/or qualifications you have acquired from previous experience or employment. Include anything you feel may be helpful when considering your application.
EMPLOYMENT HISTORY
Employers
Name Dates of Employment Position & Pay Rate City, State, Zip Duties Performed Phone Supervisors Name & Title Reason for Leaving
PROFESSIONAL REFERENCES
Professional References
Name Title Company Phone Email
ACKNOWLEDGEMENT & SIGNATURE
1. I certify the information provided in this application is true and complete to the best of my knowledge. misleading information given in my application or interview(s) may result in discharge.
2. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
3. I authorize South Dakota Partners Inc. to contact all references listed within this application. I authorize all parties listed to provide any and all information concerning my previous employment and release all parties from all liability and/or damage that could result from the information provided.
4. I understand and agree that if hired, my employment is at will and that under state law I have the right to terminate my employment at any time and for any reason, and that South Dakota Partners Inc. has the same right to terminate my employment at any time for any reason.
Signature
Name
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Name	City & State	Type of Degree	Major Course of Study	Degree Received?

Name	Dates of Employment	Position & Pay Rate	City, State, Zip	Duties Performed	Phone	Supervisors Name & Title	Reason for Leaving

APPLICANT INFORMATION

EMPLOYMENT INFORMATION

EDUCATION & TRAINING

EMPLOYMENT HISTORY

PROFESSIONAL REFERENCES

ACKNOWLEDGEMENT & SIGNATURE

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