Palisade Manor
920 4th Street
Garretson, SD 57030

605.594.3466

Employment

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* Position applied for

* How did you learn about us?
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* Last Name
* First Name
Middle Name
* Address
* City
* State
* Zip Code
* Telephone Number
E-Mail Address

* If you are under 18 years of age, can you provide required proof of your eligibility to work? Yes No
* Have you ever filed an application with us before? Yes No
If Yes, give date.
* Have you ever been employed with us before? Yes No
If Yes, give date.
* Do any of your friends or relatives, other than spouse, work here? Yes No
* Are you currently employed? Yes No
* May we contact your present employer? Yes No
* Are you prevented from lawfully becoming employed in this country because of visa or immigration status?
Proof of citizenship or immigration status will be required upon employment.
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* Date available for work:
* What is your desired salary range?
Are you available to work:
Full-Time (please indicate shift)

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Part-Time (please indicate time)

Morning Afternoon
Evening

Temporary (please indicate dates)

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* Are you currently on "lay-off" status and subject to recall? Yes No
* Can you travel if a job requires it? Yes No

EDUCATION
High School/GED:
Name and Address of School:
Course of Study:
Number of Years Completed:
Did you graduate?
Yes
No
Not Applicable
Undergraduate College:
Name and Address of School:
Course of Study:
Number of Years Completed:
Did you graduate?
Yes
No
Not Applicable
Other (Specify):
Name and Address of School:
Course of Study:
Number of Years Completed:
Did you graduate?
Yes
No
Not Applicable
 
Describe any specialized training, apprenticeship, skills, and extra-curricular activities.
 
Describe any job-related training received in the United States military.

EXPERIENCE:
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Equally Opportunity Provider and Employer!

Monday, 16 July, 2018 10:56 am