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Application for Employment

  1. Roosevelt City

    255 S State Street
    Roosevelt, Utah 84066
    Phone: 435-722-5001
    Fax: 435-722-5000

  2. We consider applicants for all positions without regard to race, color; religion, creed, gender, national origin, age, disability, martial or veteran status, or any other legally protected status.

  3. What Department

  4. How did you learn about the position?

  5. Mailing Address

  6. If you are under 18 years of age, can you provide required proof of your eligibility to work?

  7. Have you ever filed an application with us before?

  8. Have you ever been employed with us before?

  9. Do any of your friends or relatives other than spouse work here?

  10. Are you currently employed?

  11. If yes, may we contact your present employer?

  12. Are you prevented from lawfully becoming employed in country because of Visa or Immigration Status?

    Proof of citizenship or immigration status will be required upon employment

  13. When are you available to work?

  14. Are you currently on "Lay-Off" status and subject to recall?

  15. Can you travel if a job requires it?

  16. Education

  17. High School

  18. Undergraduate College

  19. Graduate / Professional

  20. Other

  21. Work Experience

    Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

  22. May we contact Employer?

  23. May we contact Employer?

  24. May we contact Employer?

  25. May we contact Employer?

  26. If this does not apply to you check N/A

  27. You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or protected status.

  28. Specialized Skills

    Check all that apply

  29. Office

  30. Computer Software You Are Familiar With and Have Used

  31. Machinery / Equipment

  32. Other Experience In

  33. Language(s) You Can Speak

  34. Personal / Professional References

    (Do not include family members or past supervisors)

  35. Applicant's Statement

    I certify that answers given herein are true and complete.
    I authorize investigation of all statements contained in this application for employment as be necessary in arriving at an employment decision.
    This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applicants are being accepted at that time.
    I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with This organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may may discharge Employee at any time with or without cause. It is further understood that this “at will” employment Relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
    In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also that I am required to abide by all rules and regulations of the employer.

  36. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  37. Leave This Blank:

  38. This field is not part of the form submission.