Present Address

Employment Desired

Personal Information

Education, Training, and Experience

Employment History

List below all present and past employment starting with your most recent employer (last five years is sufficient). Account for all periods of unemployment. You must complete this section even if attaching a resume.

Dates of Employment:

Dates of Employment:

References

List below three persons not related to you who have knowledge of your work performance within the last three years.

I hereby certify that I have not knowingly withheld any relevant information and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any false or misleading information on this application or any document used to secure employment or any dishonesty in connection with any aspect of the hiring process shall be grounds for rejection of this application, refusal of employment, removal of my name from an employment list, and/or dismissal from employment with SDRMA (regardless of when the information is learned).

I hereby authorize SDRMA to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references and former employers I have listed to disclose to the SDRMA any and all information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby fully and completely release and hold harmless SDRMA, my former employers, my former managers, supervisors, and co-workers, and all other persons, corporations, partnerships and associations from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure.

I understand that nothing contained in the application, other recruitment materials, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and SDRMA. My employment with SDRMA is "at will." This means the employment relationship between me and SDRMA can be terminated at any time with or without cause and without prior notice, at the option of either SDRMA or me. I understand that all employer decisions, including but not limited to demotion, promotion, disciplinary action, and the like, are also "at-will," meaning these decisions are made at the sole discretion of SDRMA, with or without cause and with or without notice. I further understand that my at-will employment status may be modified only by a written employment agreement signed by the CEO.

Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment) be conducted by internal personnel employed by SDRMA, I am entitled to copies of any such public records obtained by SDRMA unless I mark the check box below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have checked the box below.

I waive receipt of a copy of any public record described in the paragraph above.

If driving is an essential function of the position for which I am applying, I understand that I am required to possess a valid driver’s license. I further understand that, if driving is an essential function of the position for which I am applying, continued maintenance of a valid driver’s license, insurability according to SDRMA’s insurer, and compliance with established SDRMA vehicle operation standards are a condition of employment.

I understand that, if I progress through the application process and receive a conditional job offer, I will be required to disclose information about certain criminal convictions as part of the recruitment and selection process. No applicant will be denied employment with SDRMA solely on the grounds of conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances, and the relevance of the offense to the position applied for will be considered.