212008-08-18T22:38:00Z2008-08-19T21:06:00Z2008-08-19T21:06:00Z56643788 318444412Application for EmploymentDistrict 6 HRDC300 1st Ave. North, Suite 203Lewistown, MT 59457406-535-7488 PLEASE PRINTEqual access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.Position(s) applied forDate of applicationNameLastFirstMiddleSocial Security #E-mail AddressAddressStreetCityState Zip CodeTelephone #Mobile/Beeper/Other #Referral Source (How did you hear about us?)If you are under 18 and it is required, can you furnish a work permit?YesNoIf no, please explain:Have you ever been employed here before?YesNoIf yes, give dates and positions:Are you legally eligible for employment in this country?YesNoDate available for work:What is your desired salary range?Type of employment desired:Full-TimePart-TimeTemporarySeasonalEducational Co-opAre you able to perform the essential functions of the job for which you are applying (with or without reasonable accommodation?) This question is not designed to elicit information about an applicant’s disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.YesNoNeed more information about the job’s “essential functions” to respond.Driver’s license number:State:Answering “yes” to either of the following questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness, and nature of the violation, rehabilitation, and position applied for will be taken into account. Have you ever pleaded “guilty” or “no contest” to, or been convicted of a crime?YesNoIf yes, please provide date(s) and details:EMPLOYMENT HISTORYStarting with your most recent employer, provide the following information.