Angus Palm Application Form – Fill Out and Use This PDF

PO Box 610 – 315 Airport Drive

Watertown SD 57201-0610

Bus (605) 886-5681

Fax (605) 884-1485

www.angus-palm.com

EOE/AA/M/F/D/V

Application for Employment

EEO Policy

Angus-Palm maintains a policy of non-discrimination for all employees and applicants in every facet of the company’s operation. In compliance with federal and state laws, Angus-Palm hires, trains and promotes qualified

applicants and employees without unlawful discrimination on the basis of race, ethnicity, color, gender, gender

identification, age, religion, creed, military status, national origin, veteran’s status, disability, genetic information or

any other classification protected under federal, state or local law.

PLEASE NOTE: Answer each question fully and accurately. No action can be taken on this application until all questions are answered. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.

This application will remain active for ninety (90) days from the date of the application.

Consideration for employment after ninety (90) days requires a new application.

PLEASE PRINT

Open Position Applied For (Please list the open position you are applying for otherwise your application		Date of Application
cannot be considered –– listing “any”, “all”, etc is not acceptable – the specific job must be designated such as
material handler, welder, etc. Please ask for a list of current openings if you are unsure. One position per
application.)
How Did You Learn About Us? (Please specify source)
□ Referred by current employee (please list one)_________________	□ Walk-In
□ Job Fair ___________________________________________	□ Advertisement _________________________
□ Friend/Relative ______________________________________	□ Newspaper ___________________________
□ Employment Agency/Recruiter __________________________	□ Website ______________ □ Radio ________
□ South Dakota Department of Labor	□ Other ________________________________

NAME

______________________________________________________________________________________________

LastFirstMiddle

ADDRESS

______________________________________________________________________________________________

	Number	Street		City	State	Zip
	Home Telephone Number (Area Code)			Cell Phone Number (Area Code)		Social Security Number (Optional)
	Email Address (Optional)
	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 ____________________
	Are you over 18 years of age?					□Yes	□ No
	Are you legally eligible for employment in the United States?					□Yes	□ No
	Proof of citizenship or immigration status will be required upon employment.
	On what date would you be available for work?				Date _____________________________

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Are you available to work: (check all that apply)	□ Full-Time	□ Part-Time		□ Temporary
Are you available to work: (check all that apply)	□ 1st Shift	□ 2nd Shift	□ 3rd Shift		□ Weekend
Have you ever been convicted of a felony in the last ten (10) years?					□Yes	□ No

If yes, please provide details __________________________________________________________________________

__________________________________________________________________________________________________________________________

(A “yes” answer does not automatically disqualify you from employment since the nature of the offense, date, rehabilitation and the job for which you are applying is also considered)

___________________________________________________________________________________________________________________________

Education

	School	Name & Location	Course of Study	Number of Years	Degree or Diploma
				Completed	Received

High School

Technical School

College or

Graduate School

Other Education or Training

Professional License or Membership: ___________________________________________________________________

License Number: ___________________________________ Expiration Date: _________________________________

(You need not disclose membership in professional organizations that may reveal information regarding race, ethnicity, color, religion, gender, national origin, disability, sexual orientation, genetic information or other protected status)

_________________________________________________________________________________________________

Employment Experience

Start with your present or last job. Include military service and account for any periods of unemployment. You may exclude organizations which indicate race, ethnicity, color, religion, creed, gender, gender identification, national origin, disability, sexual orientation, genetic information or any other classification protected under federal, state or local law.

Employer

Dates Employed

			From		To	Work Performed
Address
Telephone Number			Hourly Rate/Salary
			Starting		Final
Job Title		Supervisor
Reason for Leaving
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Employment Experience (Cont.)

Employer

Dates Employed

		From		To	Work Performed
Address
Telephone Number		Hourly Rate/Salary
		Starting		Final
Job Title	Supervisor
Reason for Leaving
Employer		Dates		Employed
		From		To	Work Performed
Address
Telephone Number		Hourly Rate/Salary
		Starting		Final
Job Title	Supervisor

Reason for Leaving

How many jobs other than those listed above have you had in the last 5 years? __________________________________

Are you currently employed?□Yes □ No

If yes, whom do you suggest we contact? _______________________________________________________________

May we contact your past employers for references?□Yes □ No If no, please explain: _______________________________________________________________________________

Have you worked or attended school under any other name?□Yes □ No

If yes, give names: _________________________________________________________________________________

___________________________________________________________________________________________________________

Special Skills and Qualifications

Summarize any skills, additional training and qualifications. State any additional information you feel may be helpful to us in considering your application:

________________________________________________________________________________________________

________________________________________________________________________________________________

What machines or equipment can you operate that are related to the job for which you are applying?

________________________________________________________________________________________________

________________________________________________________________________________________________

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Applicant’s Certification and Agreement:

I certify that all information I have supplied in this application and in any other form, oral or written, is true, complete, and accurate. I understand that any misrepresentation, omissions of facts, or incomplete answers in any application document, or any other form, oral or written, will disqualify me from further consideration of employment. I further understand that, if employed, any misrepresentations or omissions of facts in any applicant form, oral or written; will be cause for my dismissal at any time, without prior notice.

I understand, if employed, my employment with Angus-Palm is not for a specific term and may be terminated by me or Angus-Palm with or without notice or cause at any time. I further understand that no oral promise, employer policy, custom, business practice, or other procedure (including the Employee Handbook) or any other personnel manual, constitutes an employment contract or modification of the at-will employment relationship between me and Angus-Palm.

I understand that applicants for certain positions may be required to qualify for employment based on additional employment criteria. For example, I may be required to take job-related tests, take a driver’s examination, submit to a background investigation, or take a pre-

employment drug test. If I am offered employment to start work before any required test is complete, my employment is contingent on a satisfactory result on all required tests.

I authorize Angus-Palm to contact my prior employers, and other sources of information regarding my background, and I hereby authorize and direct each such employer and source of information to answer any and all questions regarding my prior employment background, and I hereby authorize and direct each such employer and source of information to answer any and all questions regarding my prior employment and background. I hereby indemnify Angus-Palm, each of my prior employers, and each of the other sources of information contacted and agree to hold harmless from any claims arising from this authorization and direction.

I understand that Angus-Palm maintains a drug-free workplace and agree that maintenance of same is essential to the safety of the workplace and employees. I promise to abide by Angus-Palm’s policies prohibiting the use or possession of drugs, alcohol, or any controlled substance, or the misuse of prescribed or over-the-counter medicine on company premises or while on duty. I also understand that I may be tested for drugs, alcohol or controlled substances if I am employed by Angus-Palm.

I understand that I must meet the employability requirement of the U.S. Citizenship & Immigration Service and submit appropriate documents to satisfy the requirements for completing DHS Form I-9.

I understand and agree that work schedules and requirements vary and can be unpredictable, and that, while Angus-Palm will make reasonable efforts to accommodate work schedules and employee availability, I may be required to work overtime, weekends, different shifts, or other agreements. I consent to these requirements as necessary and legitimate conditions of employment.

I understand that this application will be considered active for ninety (90) days from this date. If I have not heard from Angus-Palm at the conclusion of the ninety (90) day period, it is my responsibility to complete a new application if I wish to be considered for employment.

I have read and understand everything on this application. I further understand that my signature is required in order for this application to be considered.

	______________________________________________________					___________________________________
	Applicant’s Signature					Date
			FOR PERSONNEL DEPARTMENT USE ONLY
		Arrange Interview	Yes	No
		Remarks:___________________________________________________________________________________
	_______________________________________________				_________________________________________
					Interviewer		Date
		Employed	Yes	No	Date of Employment______________________

Job Title _______________________Hourly Rate/Salary_______ Department_____________________________

By______________________________________________	_____________________________________
Name & Title	Date

DESIGNERS AND MANUFACTURERS OF QUALITY ROPS, CABS AND CUSTOM STEEL FABRICATIONS

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