APPLICATION
FOR EMPLOYMENT
We consider applicants for all positions without regard to race, color, religion, creed, gender,
national origin, age, disability, marital or veteran status, or any other legally protected status.
INCOMPLETE OR UNSIGNED APPLICATIONS WILL NOT BE CONSIDERED
Position(s) Applied For
Date of Application
Last Name
Address
First Name
Number
Street
City
Telephone Number(s)
(H)
Middle Name
State
Zip Code
Social Security Number
Email
(C)
How Did You Learn of This Opening?
 Advertisement
 Friend
 Inquiry
 Employment Agency
 Other ___________________
Are you currently employed?
 Yes
 No
Do you want to be informed before we contact your present employer for references?
 Yes
 No
If hired can you show proof of authorization to work in the United States?
 Yes
 No
(Proof of citizenship or immigration status will be required upon employment).
Date available for work ________/_________/_________
Are you available to work:  Full Time
 Part Time
What is your desired salary range? ______________________
 Temporary
(Please indicate dates available _____/_____ - _____/_____)
Do you have experience in or have you ever worked in a similar business or occupation before?
 Yes
 No
 Yes
 No
If yes, please explain: _________________________________________________________
Have you been convicted of a felony? (Conviction will not necessarily disqualify you from employment)
If yes, please explain
WE ARE AN EQUAL OPPORTUNITY EMPLOYER
PRIOR WORK HISTORY (List in order, last or current employer first. Account for any gaps in your employment. If
you need more room to complete your prior work history, use additional sheets of paper.) You may also attach a resume.
1. Employer Name
Employer Address
Telephone
Dates Employed
Supervisor's Name/Title
Reason for Leaving
Rate of Pay
Describe in detail the work you performed. Include information about the tasks you performed and the equipment you used (If you need more room to
complete your prior work history, use additional sheets of paper.)
2. Employer Name
Employer Address
Telephone
Dates Employed
Supervisor's Name/Title
Reason for Leaving
Rate of Pay
Describe in detail the work you performed. Include information about the tasks you performed and the equipment you used.
3. Employer Name
Employer Address
Telephone
Dates Employed
Supervisor's Name/Title
Reason for Leaving
Rate of Pay
Describe in detail the work you performed. Include information about the tasks you performed and the equipment you used
EDUCATION
School
Name and Address
of School
Course of Study
Years
Completed
Diploma/
Degree
High School
Undergraduate
College
Graduate
Professional
Other
(Specify)
SPECIALIZED SKILLS
Describe any other job related specialized training or skills acquired from employment, the United States military or
other experience that you believe may help you qualify for the position for which you are applying.
_________________________________________________________________________________________________
APPLICANT’S STATEMENT
I certify that the information provided herein and attached to this Application for Employment is true and complete.
I authorize the Company and its agents to investigate all statements contained in this Application for Employment as may
be necessary in arriving at an employment decision.
In the event of employment, I understand that false, misleading information or material omissions given in my application
or interview(s) may result in discharge. I understand, also, that I am required to abide by all company policies and procedures
and that they may from time to time be changed, suspended, revoked, terminated or superseded by the Board of Directors
and/or Company management.
Signature of Applicant
Date
VOLUNTARY APPLICANT SURVEY
Title VII of the federal Civil Rights Act of 1964 and the Montana Human Rights Act require us to make and keep records
relevant to providing equal employment opportunities for various groups of employees and job candidates. The following
questions provide us with information to help fulfill these requirements.
This applicant survey will be separated from your application. The survey information will be kept confidential, used only for
statistical reports and other lawful uses.
Because this sheet is separated from your application, please give us your name, address and phone number again. State
of Montana has a Human Resource System that automates recruitment information. To prevent duplicate records, please
answer the following questions. Thank you for your cooperation.
Job Applied For: Department Job Title
Position No. Closing Date Location
REFERRAL SOURCE - How did you FIRST learn of this position?
___ Newspaper Ad ___ Walk-In ___ Job Service Posting
___ Internet Listing ___ Phone Inquiry
___Another Employee
Other ________________________________________
___ AGE 18 OR OLDER – Please leave blank if under the age of 18.
___ FEMALE ___ MALE
RACE/ETHNIC IDENTIFICATION – PLEASE CHECK ALL THAT APPLY
Are you of Hispanic or Latino origin? Yes __ No __ (A person of Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture or origin, regardless of race.)
SELECT ONE OR MORE OF THE FOLLOWING RACIAL CATEGORIES:
___ American Indian or Alaska Native (A person having origins in any of the original peoples of North or South America,
including Central America, and who maintains tribal affiliations or community attachment.)
___ Asian (A person having origin in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent.)
___ Black or African American (A person having origins in any of the black racial groups of Africa.)
___ Native Hawaiian or other Pacific Islander (A person having origins in the original peoples of Hawaii, Guam, Samoa,
or other Pacific islands.)
___ White (A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.)
MILITARY STATUS – Please check the one box that best describes your military status.
___ No Military Service ___ Reserve or National Guard
___ Retired
___ Vietnam Veteran
___ Disabled Veteran
___ Other Veteran