Online Application

LifeQuest in Mitchell South Dakota is an Equal Opportunity Employer and fully subscribes to the principles of Equal Opportunity. Applicants will not be discriminated for or against on the basis of race, color, ethnic or national origin, ancestry, religion, gender, political affiliation, veteran status, physical or mental disability, marital status, or age. To protect the interests of the people we serve, all job offers are conditional pending acceptable results of a criminal background check, a substance abuse screening, a tuberculin test, and a motor vehicle record check. All applicants must be 18 years old, have a valid drivers license, and have a High School Diploma or GED.

PERSONAL INFORMATION

Name (required)

Address - Street, City, State, Zip Code (required)

Email Address

Example: janedoe@fakeemail.com

Phone Number (required)

Example: (###)###-####

EMPLOYMENT DESIRED

Position Desired (required)

Hours Wanted (required)

Full Time

Part Time

Either

Have you applied to LifeQuest Before(required)

If yes, when did you apply

Have you been employed by LifeQuest previously(required)

If yes, when

If you currently have a relative employed by LifeQuest please give their name and relationship

If you marked Other please specify

If you were referred by a LifeQuest employee please give their full name

MISCELLANEOUS

Do you require special accommodations for an interview(required)

If yes, please explain

Do you have a valid driver's liscense(required)

Have you ever been convicted of a felony(required)

List special skills or experiences that may be related to the position applied for

EDUCATION

Have you earn a High School Diploma or GED(required)

Name and Location of School Attended, Highest Degree Earned, Course of Study (required)

WORK EXPERIENCE

May we contact you present or most recent employer(required)

Please provide the following information for three work experiences: Name of Employer, Employer Address and Phone Number, Your Supervisors Name, Your Dates of Employment, Your Job Title and Brief Description of Duties, and Reason for Leaving

Work Experience #1 (required)

Work Experience #2 (required)

Work Experience #3 (required)

REFERENCES

List three references. One of your references may be a personal reference but not related to you. Include name, occupation, phone number, and type of reference (personal or business).

Reference #1 (required)

Reference #2 (required)

Reference #3 (required)

PLEASE READ THE FOLLOWING CAREFULLY

I certify that the information contained in this application is correct to the best of my knowledge and that any misstatement or omission of information is cause for cancellation of the application and/or separation from employment.

Signature (required)

Date (required)

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