Forms | City of Huron, South Dakota

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*First Name:
Middle Initial:
*Last Name:
Social Security #:
*Street Address:
*City:
*State:
*ZIP:
*Phone:
Work Phone:
Email:

Are you age 18 or older?	Yes No**
**If no, what is your age?
Are you age 21 or older? (Police Only)	Yes No**
**If no, what is your age?
Are you authorized to work in the U.S.?	Yes No**
**If no, Permanent Residency or Work Permit No:
Have you ever plead guilty or been convicted of a crime that would effect your fitness to perform this job? (Exclude misdemeanor traffic violations. Conviction of a crime does not automatically bar you from employment)	Yes** No
**If yes, date:
**Offense:
Are there any charges pending in this state or other states which may inhibit your ability to perform in this position?	Yes** No
**If yes, explain:
Is any additional information relative to change of name, use of assumed name, maiden name, or nickname necessary to conduct a check of your work record?	Yes** No
**If yes, explain:
If this position required a Driver's License do you have a valid Driver's License?	Yes** No
**License Number:
**Expire Date:
**State:
*Do you claim Veteran's preference?:	Yes No If yes, email a copy of DD214 (separation papers) to hrdirector@huronsd.com or mail to: Human Resources PO Box 1369 Huron, SD 57350

Position Applied For:
Date Available for work:
Are you willing to work nights, weekends and holidays?	Yes No
Referral?	Yes** No
**If yes, who?
Name(s) and relationship of relative(s) in our employ (If none, write "None"):
Have you been previously employed by the City of Huron?	**Yes No
**If yes, when?
**Position:

Are you licensed, registered or certified in a profession or trade?	Yes No
If yes, identify the profession or trade name:
License / Permit / Certification Number:
State:
Expire Date:
Use this space to identify any other educational experiences you have had which are pertinent to this position. Include workshops, seminars, military or vocational training, computer software, etc. which are not listed above. Indicate time involved (hours per week, number of weeks, number of credits, etc.)
List any relevant certificates, licenses or registrations you possess or for which you are eligible. Include expiration dates.

Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary $:
Ending Salary $:
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?	Yes No

Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary $:
Ending Salary $:
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?	Yes No

Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary $:
Ending Salary $:
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?	Yes No

Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary $:
Ending Salary $:
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?	Yes No

*Digital Signature:
Date:
Witness to applicant signature:	If applicant is 17 years of age or under, then a parent or legal guardian must witness the applicant's signature.
Witness Digital Signature:
Date:

Employment Application Form