Employment

APPLICATION FOR EMPLOYMENT

NORTHERN HILLS TRAINING CENTER
625 Harvard Street
Spearfish, SD 57783-1897
Prospective employees will receive consideration without discrimination for race, creed, color, sex, age, national origin, handicap, or veteran status.

 

POSITIONS

Direct Support Professional

 

PERSONAL

Last Name
First Name
Middle
Street Address/P.O. Box
City
State
Zip
Home Phone (___-___-_____)
Email Address
Are you over the age of 18?
Yes No
Salary Desired:
Are you legally eligible for employment in the US?
Yes No
Have you ever worked for NHTC?
Yes No
If yes: Year of last employment
Have you ever applied for employment with us?
Yes No
If yes: Application Date:
Month Year
How did you hear about the position?
Classified Ads NHTC Website TV Commercial SD Dept. of Labor
Employee Referral BHSU Social Media Former Employee Family Member
If Employee Referral or Former Employee. Please list name:
Hours available to work:
Full-Time Part-Time Temporary
Mon
Tues
Wed
Thurs
 Fri
 Sat
 Sun
Scheduling Requests:

EDUCATION

Yes No
Business/Trade/Technical
Yes No
College
Yes No
Graduate School
Yes No
Have you been convicted of a crime:
Convictions are not an absolute bar to employment
Yes No
If Yes - describe in full: (Max 125 characters)
 Exceeded maximum number of characters.
Do you have a valid Driver’s License?
Yes No
If Yes - State of issue:
Do you have vehicle insurance?
Yes No
Have you had any accidents in the last 3 years?
Yes No
If Yes - How many?
Have you had any moving violations in the last 3 years?
Yes No
If Yes - How many?

Previous Employment

Name of Employer:
Name of Supervisor
Employed
From: / To: /
Complete Address
Telephone (___-___-_____)
Last Job Title
Reason for Leaving (150 characters Max)
 Exceeded maximum number of characters.
List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company: (175 characters Max)
 Exceeded maximum number of characters.
Name of Employer:
Name of Supervisor
Employed
From: / To: /
Complete Address
Telephone (___-___-_____)
Last Job Title
Reason for Leaving (150 characters Max)
 Exceeded maximum number of characters.
List the jobs you held, dutites performed, skills used or learned, advancements, or promotions while you worked at this company: (175 characters Max)
 Exceeded maximum number of characters.
Name of Employer:
Name of Supervisor
Employed
From: / To: /
Complete Address
Telephone (___-___-_____)
Last Job Title
Reason for Leaving (150 characters Max)
 Exceeded maximum number of characters.
List the jobs you held, dutites performed, skills used or learned, advancements, or promotions while you worked at this company: (175 characters Max)
 Exceeded maximum number of characters.

Professional References

 
1.
2.
 

Personal References

 
1.
2.
Use this space to add any additional information necessary to describe your full qualifications for the position which you are applying:
(Max 125 characters)
 Exceeded maximum number of characters.

NORTHERN HILLS TRAINING CENTERPARTIAL

CONDITIONS OF EMPLOYMENT

NHTC will hold your application for 1 year unless notified by you to withdraw your application from consideration

I certify that I have read and understand all of the information requested in the above application for employment. I agree and understand that the employer or his agents may investigate my background to obtain any and all information of concern to my employment history, whether same is of record or not, and I release employers and other persons named herein from all liability for any damages on account of furnishing such information. I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks which are pertinent to the job. I also understand that if offered a job, it may be conditioned on the results of a physical examination and drug test.

I further certify that I am a genuine applicant for employment at NHTC and this application is being submitted solely for the purpose of seeking employment with NHTC and for no other reason.

I agree to furnish such additional information and complete such examinations as may be required to complete my employment file. I also understand that misrepresentation or omission of facts and information may result in immediate rejection or dismissal if hired.

If hired, I agree to follow and comply with all rules and policies of NHTC.

This certifies that this application was completed by me, and that all information contained in the above application is true and complete to my best knowledge.

You must agree to this before proceeding. I AGREE
 
I UNDERSTAND AND AGREE THAT: It is my understanding that Northern Hills Training Center (NHTC) may make a thorough review of my experience and education and may verify all application and/or oral interview materials. I authorize such review and the giving and receiving of any information, requested by NHTC. I release from liability any person giving or receiving such information. Falsification, misrepresentation, or omission of facts so given, or other derogatory information discovered as a result of this review may prevent my being hired, or if hired, may subject me to immediate dismissal. Although the NHTC makes every effort to accommodate employee preferences, the needs of persons served by the NHTC may at times, make the following conditions mandatory: overtime, shift work, holidays, a rotating schedule, and/or a work schedule other than which I may have hired for. I understand and accept these conditions of my future or continuing employment. I understand that If I am employed, I am employed for an indefinite period of time and the NHTC may change wages, benefits, and conditions of my employment at any time. In consideration for EMPLOYMENT and by being considered for employment by the NHTC, I agree to follow the policies, rules and regulations of the NHTC, and acknowledge that these policies, rules and regulations may be changed, interpreted, withdrawn, or added to by the NHTC at any time, at its discretion, and without any prior notice to me. I further acknowledge that my employment may be ended per personnel policies. I understand that representatives of the NHTC do not have the authority to enter into any agreement for employment for any specified period of time. Further, no representative of the NHTC may guarantee other personnel moves either prior to commencement of employment or after I have become employed. Assurances of any benefits or terms and conditions of employment, or any agreement contrary to the foregoing, may not be entered into. The NHTC reserves the right, due to Federal Medicaid Regulations and other state and federal laws, to complete criminal records, Department of Human Services, Motor Vehicle, and other eligibility for employment checks on all applications and employees. I understand that Northern Hills Training Center is a Drug and Alcohol-Free Workplace and that I will be submitted to random drug/alcohol testing per NHTC policy. I understand that the position I am applying for (if involving direct service responsibilities) may involve implementing crisis prevention and intervention services which may include lifting, pulling and guiding persons with disabilities against potential resistance. I understand this as a condition of employment and have no reason to believe I cannot implement these or other responsibilities of the position for which I am applying. I have read, had the opportunity to ask questions, and understand the above.

You must agree to this before proceeding.I AGREE

PROSPECTIVE EMPLOYEES SHALL RECEIVE CONSIDERATION WITHOUT DISCRIMINATION BECAUSE OF RACE, COLOR, CREED, SEX, SEXUAL ORIENTATION, AGE, ETHNIC OR NATIONAL ORIGIN, MARITAL STATUS, HANDICAP (IF OTHERWISE QUALIFIED), AGAINST VETERANS OF THE VIETNAM ERA OR AGAINST VETERANS WITH DISABILITIES.
 
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