SAM Employment Application

Basic Information

Position applied for

Full Name

First Name

Initial

Last Name

How many residences have you had, in the past 10 years?

Full Address

Street Address

City

State

Zip

Full Address

Street Address

City

State

Zip

Full Address

Street Address

City

State

Zip

Full Address

Street Address

City

State

Zip

Full Address

Street Address

City

State

Zip

Full Address

Street Address

City

State

Zip

Full Address

Street Address

City

State

Zip

Full Address

Street Address

City

State

Zip

Full Address

Street Address

City

State

Zip

Full Address

Street Address

City

State

Zip

Full Address

Street Address

City

State

Zip

Phone Number

Have you ever been convicted of a felony?

Yes

Give details of your felony conviction

Are you required to register as a sex offender?

Yes

Are you at least 18 years of age?

Yes

Proof of U.S. citizenship or immigration status will be required upon employment. Are you legally eligible for employment in this country?

Yes

Have you ever worked or applied to work for SuTran Inc.?

Yes

If yes, when? (Click on the line below and then, if needed, click on the year to go back a year at a time instead of one month at a time.)

Dates and Position:

List any previous names

Shift available

Days

Nights

Weekends

Any hours

Availability dates:

From

Until

Driver's Licenses

Do you have a valid driver’s license?

Yes

Have you ever been denied a license, permit, or privilege to operate a motor vehicle?

Yes

If yes, give details.

Has any license, permit, or privilege ever been suspended or revoked?

Yes

If yes, give details.

Have you in the past three years failed to refused any DOT-mandated pre-employment tests?

Yes

If yes, give details.

Do you have a valid CDL?

Yes

Class & Endorsements

Driving Experience

Straight Truck

Class of Equipment

Type of Equipment (Van, Tank, Flat, etc.)

Untitled

Are you a Veteran as defined by Section 33A-2-1 under South Dakota law?

Yes

You must attach DD214 or certificate of service-connected disability from the VA.

The relevant portion of SDCL 33A-2-1 defines Veteran as any person who:

(1) Has served the full obligation for active duty, reserve, or National Guard service in the military, or received an early discharge for a medical condition, hardship, reduction in force, or at the convenience of the military; and

(2) Has been separated or discharged from such service honorably or under honorable conditions.

The spouse of a Disabled Veteran who is unable to exercise the preference or an unmarried spouse of a deceased Veteran who died while in service or later died from a service-connected cause may also qualify for Veterans’ Preference.

Upload File(s): DD214 or certificate of service-connected disability from the VA

Click Here to Upload

Educational Background

High School and/or GED location

Untitled

Highest Grade/Year Completed

Last month/year attended (Click on the line below and then, if needed, click on the year to go back a year at a time instead of one month at a time.)

Currently Attending?

Yes

Graduated?

Yes

GED

Date of graduation

Month

Day

Year

Post-Secondary Education

Vocational/Technical College

College/University

Graduate School

Vocational/Technical College:

Currently Attending?

Yes

Graduated?

Yes

Major/Minor

College/University:

Currently Attending?

Yes

Graduated?

Yes

Major/Minor

Graduate School:

Currently Attending?

Yes

Graduated?

Yes

Major/Minor

Employment Application

Attach resume if available

Click Here to Upload

Employment History

If applicable, all employement history for the previous 10 years required.

Employer Name

Employer Address

Street Address

City

State

Zip

Employer Phone Number

Employed From (MM/YYYY)

Employed To (MM/YYYY)

Reason for Leaving

Supervisor's Name

Supervisor's Title

Salary

Position Title

Responsibilities

Add more Work Experience

Yes

Employer Name

Employer Address

Street Address

City

State

Zip

Employer Phone Number

Employed From (MM/YYYY)

Employed To (MM/YYYY)

Reason for Leaving

Supervisor's Name

Supervisor's Title

Salary

Position Title

Responsibilities

Add more Work Experience

Yes

Employer Name

Employer Address

Street Address

City

State

Zip

Employer Phone Number

Employed From (MM/YYYY)

Employed To (MM/YYYY)

Reason for Leaving

Supervisor's Name

Supervisor's Title

Salary

Position Title

Responsibilities

Add more Work Experience

Yes

Employer Name

Employer Address

Street Address

City

State

Zip

Employer Phone Number

Employed From (MM/YYYY)

Employed To (MM/YYYY)

Reason for Leaving

Supervisor's Name

Supervisor's Title

Salary

Position Title

Responsibilities

Add more Work Experience

Yes

Employer Name

Employer Address

Street Address

City

State

Zip

Employer Phone Number

Reason for Leaving

Employed From (MM/YYYY)

Employed To (MM/YYYY)

Supervisor's Name

Supervisor's Title

Salary

Position Title

Responsibilities

Upload additional work experience if needed.

Click Here to Upload

References

Please provide the name and contact information for two references

Full Name

First Name

Last Name

Daytime Phone Number

Full Address

Street Address

City

State

Zip

Full Name

First Name

Last Name

Daytime Phone Number

Full Address

Street Address

City

State

Zip

Employment Application

Language skills other than English: List the languages and indicate your knowledge (fluent/good/limited)

Other qualifications such as special skills, abilities or honors that should be considered

Group Status

Hispanic or Latino (Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race)

White

Black or African American

Native Hawaiian or Other Pacific Islander

Asian

American Indian or Alaska Native

Two or more races (not Hispanic or Latino

Pre-employment Agreement

I understand and agree that:

If I misrepresent or deliberately leave out a fact in my application, I may be refused employment or, if employed, my employment may be terminated.
The City has my authorization to thoroughly investigate my work, medical, and personal history that is job-related. I will hold no person, corporation, or organization liable for giving or receiving information in this investigation.
The City has my authorization to conduct a court record check as needed. I agree on behalf of myself or anyone representing me that I will hold harmless the City of Sioux Falls from liability for any claim or damages resulting from the release of this information to the City.
In consideration of my employment, I agree to conform to the rules and regulations of the City and I understand that no representative of the City has any authority to enter into any agreement, oral or written, for employment for any specified period of time or to make any agreement or assurances contrary to this policy.
The City is an equal opportunity employer. The City does not discriminate and no question on this application is used for the purpose of limiting or excluding any applicant’s consideration for employment on a basis prohibited by local, state, or federal law.
If employed, I understand that my employment is for no definite period of time, and if my employment is terminated, the City is liable only for wages and salary and benefits earned as of the date of termination.
This application is current and active for only the position applied for, and it will be necessary for me to fill out a new application for other positions that may be available.
I have read and agree to the above and hereby certify that the facts I have provided in my employment application are true and complete.

By checking this box, I affirm that the information provided on this application is true and correct to the best of my knowledge.

Agree

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

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