Online Application for Employment

Online Application Policy. It is the policy of Valiant Living to provide equal employment opportunities to all employees and applicants for employment. No person shall be discriminated against in employment because of race, color, religion, sex, age, national origin, or disability. If, due to a disability, a reasonable accommodation is needed to complete the application, please contact Human Resources at (phone) 605-256-6628.


* fields are required.

Personal Information

+

12/16/2017


(example: 555-555-5555)

(example: 555-555-5555)

(example: myname@example.com)

Home Phone
Cell Phone
Email


(example: Madison, SD 55555)

Personal History

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Yes
No


M-F days
Evenings/Weekend
Weekends Only
Overnights
Any PT
Any FT

Yes
No


(example: 01/01/2016)


Yes
No

Employment History

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List below present and past employment, beginning with your most recent:

(example: Madison, SD 55555)
(example: 555-555-5555)

to


(example: 01/01/2016)


(example: Madison, SD 55555)
(example: 555-555-5555)

to


(example: 01/01/2016)


(example: Madison, SD 55555)
(example: 555-555-5555)

to


(example: 01/01/2016)


(example: Madison, SD 55555)
(example: 555-555-5555)

to


(example: 01/01/2016)


I desire that Valiant Living be fully advised of my record with former employers. Therefore, I request and authorize the release of information from my records in response to any requests from Valiant Living. I understand that the information I am authorizing to release includes factual employment information and also can involve records or assessments of my abilities, performance, attendance, productivity, attitude, conduct and other work-related characteristics or issues.

I hereby release from all liability of any type whatsoever arising out of or related to the reference process, and agree not to file or pursue any complaints, claims, or legal actions of any kind against the past employer, employees, representatives, or agents arising out of their activites or actions performed in connection with disclosure of information for the employers indicated below:

Yes
No

Yes
No
N/A

Yes
No
N/A

Yes
No
N/A

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Education

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(example: Madison, SD 55555)
Freshman
Sophomore
Junior
Senior


(example: Madison, SD 55555)
Freshman
Sophomore
Junior
Senior


(example: Madison, SD 55555)
Freshman
Sophomore
Junior
Senior

Personal References

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(not former employers or relatives)

(example: 555-555-5555)

(example: Madison, SD 55555)

(example: 555-555-5555)

(example: Madison, SD 55555)

(example: 555-555-5555)

(example: Madison, SD 55555)

Other

+

Yes
No

Please read and sign below

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I certify that the facts set forth in this application for employent are true and complete. I understand that any false statement on this application may disqualify me from consideration, or result in my termination. Further, I understand that this application is not a contract of employment, nor does this application obligate Valiant Living in any way. Employment at Valiant Living is at-will and can be terminated by either party, with or without notice, at any time, for any reason or no reason. No one other than an officer of the Company has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing, and then only in writing, signed by an officer.


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