Application for Employment

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including age, sex, color, race, creed, national origin, religious persuasion, marital status, political belief, or disability that does not prohibit performance of essential job function.

Fields marked with an * are required.

Contact Information

*First Name:
Middle Name:
*Last Name:
*Address:
*City:
*State / Province:
*ZIP / Postal Code:
*Home Phone:	–
Cell Phone:	–

Additional Information

Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity (valid driver's license, birth certificate, Green Card, etc.) within three days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination.
Position Applied For:
Location:	Rapid City Pierre
1. Is there any information we would need about your name or use of another name for us to be able to check your work record? Please specify.
2. Do you have any relatives who are presently (or have formerly been) employed by Pottery 2 Paint?	Yes No
3. How were you referred to Pottery 2 Paint?
4. Why do you feel you would be an asset to Pottery 2 Paint?
5. Have you ever been convicted of a felony?	Yes** No
**If yes, please explain:

Educational History

High School Years Completed:	9th 10th 11th 12th GED
High School Name:
Degree/Diploma:

College Years Completed:	One Two Three Four
College Name:
Degree/Diploma:

Tech. Training:
Other (Certification):

Employment Record

(Please include all employment for the past five years. Please list your most recent position first.)

Employer Name:
Employer Phone:	–
Manager/Supervisor Name:
Reason For Leaving:
Job Title:
Tell us about this job and your duties:
What did you like about this job?
What did you not like about this job?
Start Date:
End Date:
Summary of work performed:
May we contact this employer?	Yes No

Employer Name:
Employer Phone:	–
Manager/Supervisor Name:
Reason For Leaving:
Job Title:
Tell us about this job and your duties:
What did you like about this job?
What did you not like about this job?
Start Date:
End Date:
Summary of work performed:
May we contact this employer?	Yes No

Employer Name:
Employer Phone:	–
Manager/Supervisor Name:
Reason For Leaving:
Job Title:
Tell us about this job and your duties:
What did you like about this job?
What did you not like about this job?
Start Date:
End Date:
Summary of work performed:
May we contact this employer?	Yes No

References

Please do not include relatives or former employers.

Name:
Address:
Phone:	–
Occupation:
Length of Acquaintance:

Name:
Address:
Phone:	–
Occupation:
Length of Acquaintance:

Describe your best qualities and job skills

Work Availability

1. If your application receives favorable consideration, when will you be available to begin work?
2. Do you have any objection to working overtime?	Yes No
3. Can you work overtime without prior notice?	Yes No
4. Can you work on Saturday?	Yes No
5. Can you work on Sunday?	Yes No
6. Can you work shifts?	Yes No

Salary / Hourly Rate Requirements

If your application receives favorable consideration:

What hourly rate would you require?	$
What yearly salary would you require?	$

Technology

Are you using Facebook, Twitter or any other social platform?
Explain in detail your computer, internet and mobile device knowledge.

Application Statement

I verify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of 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 or misleading information given in my application or interview (s) may result in discharge.

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