• Walnut Village

  • Employment Application Form:

  • Answer all questions   

    Incompliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, or non-job related disability.

  • Personal Information:

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  • Employment Desired:

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  • Education:

  • Skills/Qualifications:

  • Current Employment:

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  • Previous Employment:

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  • References:

  • Avalibility

  • Please check off hours avalible for each day of the week.

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  • Cover Letter & Resume (Optional):

  • Request for background search, Check of Driving Record & Criminal History

  • I hereby authorize you to release the following information to Walnut Village, Inc for purpose of investigation as regards to employment. You are released from any and all liability, which may result from furnishing such information.

    1.    In accordance with the provisions of Section 604 and Section 607 of the Fair credit Reporting Act, Public Law No. 91-508, I hereby certify the information requested below will be used for a "permissible purpose" as defined in the Act, and that the information received will be used for no other purpose.

    2.    I further certify that if the applicant named below is denied employment based upon the information received, I will identify the source of the report in accordance with Section 615(a) of the Fair Credit Reporting Act.

    The above named person has made application with our company. The information is needed for the applicant’s driving record, criminal background, &/or drug abuse history etc.

  • Requested By

    Walnut Village

    Casey Blom

    President

    613 Walnut Street

    Yankton SD  57078

  • Send Application:

  • By clicking the submit button below, I cerity that all of the information provided by me on this application is true and complete, and I understand that if any false information, ommissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employement may be terminated at any time.  

    In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compenstation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option.  

    I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been made. I hereby release employers, schools, health care providers, and other persons from all liability in responding to inquiries and releasing information in connection with my application. In the event of employment, I understand that false or misleading information given in my application or interview may result in discharge. I understand also, that I am required to abide by all rules and regulations of Walnut Village, Inc. I hereby authorize the South Dakota Workers’ Compensation Commission to search and release any and all claims information to HIRERIGHT, Inc. 

    I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the com pany.  

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