DKM Employment Application

Full Name*

First NameMiddle Initial Last Name

Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

Birth Date*

MonthDayYear

If hired, can you provide evidence of legal eligibility to work in the U.S.?*

Any offer of employment is conditioned upon completing form l-9 and providing the appropriate documents for identity and work authorization.

Position Desired?*

Full time or Part time?*

Have you ever been convicted of a felony, or a misdemeanor involving any violent act, use or possession of a weapon, or act of dishonesty for which the record has not been sealed or expunged, or do you have such a case pending?*

yesno

If yes to question above, when and where?

Start date

MonthDayYear

Are you 18 years of age or older?*

yesno

Do you have a valid driver's license?*

DL#

State issued:

Do you have a CDL?*

yesno

Class:

High School Graduate?*

yesno

Name of high school attended:

High School City and State:

GED?*

yesno

Name of college or technical school:

Technical School City and State:

Technical or College Graduate?

yesno

Degree:

Major:

Are you currently enrolled in school?*

yesno

If yes, give name & address of school and expected degree date:

List any job related skills or accomplishments, including military service

Your availability for work*

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
From:
To:

Total hours per week you are available to work:*

Do you have any special requests or needs for a work schedule?

Give a reference who is not a current employer *

Give a reference who is not a current employer

Name of employer: *

Address: *

Supervisor

Phone #*

Job title and duties

Dates of employment*

Hourly pay or Salary

Reason for leaving*

Name of employer:

Address:

Supervisor

Phone #

Job title and duties

Dates of employment

Hourly pay or Salary

Reason for leaving

Name of employer:

Address:

Supervisor

Phone #

Job title and duties

Dates of employment

Hourly pay or Salary

Reason for leaving

I certify that all of the information provided in this employment application are true and complete to the best of my knowledge, and I authorize investigation of all statements contained in this application, including a criminal background and credit history check. I understand that any false or incomplete information may disqualify me from further consideration for employment and may result in my immediate discharge if discovered at a later date.

I understand and acknowlegde that unless otherwise defined by applicable law or written agreement with DKM, any employment relationship with DKM is considered "employment at will." This means the Employee may resign at any time and the Employer may discharge the Employee at any time, with or without cause, and with or without advance notice.

I authorize the investigation of any or all statements contained in this application and also authorize any person, school, current employer, past employers, and other organizations to provide information concerning my previous employment and other relevant information that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.

I have read, understand, and agree to the above statements.

Date*

Date

Signature*

APPLICATION FOR EMPLOYMENT

Education

Your employment History

CAREFULLY READ EACH STATEMENT BEFORE SIGNING