Application for Employment

It is our policy to comply with all applicable local, state and federal laws prohibiting discrimination in employment based on race, religion, color, sex, age, national origin, disability, military status or other protected classification.

Equal access to programs, services and employment is available to all persons. If you need help filling out this application form or for any phase of the employment process, please notify DCI Human Resources at 620.694.6800 and every effort will be made to reasonably accommodate your needs.

Please complete ALL sections of the application below, attach any documents and click Submit at the bottom when finished. Your application will be sent directly to our HR department for processing and follow up. Incomplete applications will NOT be processed.You may also submit an application by mail or fax using a print-friendly application form. If you have questions or need assistance, please contact us at 620.694.6800.

 

Applicant Information
All fields required in this section.

First Name:
 

Middle Name:
 

Last Name:
 

Address:
 

City:
  State:   Zip:   

Years at this Address:
 

Primary Phone:
  

Alternate Phone:

Email:
 

Are you below the age of 18?:
 

Position desired:
 

Full or part time?:
 

Date available:
 

Rate of pay expected:
  
 
Per:    

Will you work overtime?:
 

Any hours or days you cannot work?:
 
If yes, when?:
   

Can you meet attendance requirements?:
 

Any other employer commitments?:
 
If yes, explain:
   

Are you legally authorized to work in the United States?:
 

How were you referred to DCI?:
Have you applied with DCI before?:
 
If so, when?:
   

 


Work Experience

Please list your present and/or previous employers, beginning with your current or most recent employer. Please give accurate and complete information and be sure telephone numbers are correct for verification purposes. You must complete this section even if you attach a resume.

May we contact your most recent employer?:
 

Employer #1:

Company Name:
From: To:
Address:

City:
State:  

Telephone:

Supervisor:

Job Title:

Rate of Pay:
 
Per:  

Duties:

Reason for Leaving:

 

Employer #2:

Company Name:
From: To:
Address:

City:
State:  

Telephone:

Supervisor:

Job Title:

Rate of Pay:
 
Per:  

Duties:

Reason for Leaving:

 

Employer #3:

Company Name:
From: To:
Address:

City:
State:  

Telephone:

Supervisor:

Job Title:

Rate of Pay:
 
Per:  

Duties:

Reason for Leaving:

 

Employer #4:

Company Name:
From: To:
Address:

City:
State:  

Telephone:

Supervisor:

Job Title:

Rate of Pay:
 
Per:  

Duties:

Reason for Leaving:

 

Employer #5:

Company Name:
From: To:
Address:

City:
State:  

Telephone:

Supervisor:

Job Title:

Rate of Pay:
 
Per:  

Duties:

Reason for Leaving:

 


Skills, Training & Military Service

 

Skills:

 

Please indicate the skills at which you are proficient. (Mark all that apply)




    
    
    
    


 

Training:

 

Summarize any relevant training, skills, licenses, programming languages, certifications, etc:

 

Military Service:

 

Have you served in the U.S. Armed Forces?
 
 
Branch of Service:




 
Rank:
   

 


References
List three references familiar with your work ability that we may contact. Do not include relatives.
Name:
 

Address:
 

Telephone:
 

Relationship:
 

Years Known:
 

 


Name:

Address:

Telephone:

Relationship:

Years Known:

 


Name:

Address:

Telephone:

Relationship:

Years Known:

 


Education
High School:
School Name:

Location:

Course or Subject:

# of Years Attended

Did you graduate?

 

College or University:
School Name:

Location:

Course or Subject:

# of Years Attended

Did you graduate?

Degree

 

Other:
School Name:

Location:

Course or Subject:

# of Years Attended

Did you graduate?

Degree

 


Comments
Briefly describe why you feel you are qualified for this position or work:

 


Resume & Other Document Attachments

Upload Document #1

Upload Document #2

Upload Document #3

 


Consent & Release

Please read the following carefully before submitting this application form:

By submitting this application, I certify that all information I have provided in order to apply for and secure employment with the employer is true, complete and correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer's service, whenever it is discovered.

 

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from any and all references (personal and professional), former employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, and I release the employer and such other entities and individuals from any liability for any damages whatsoever that may result from their so doing. I also authorize all references (personal and professional), former employers, public agencies, licensing authorities and educational institutions to release any and all information concerning my background, previous employment, education or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application, and I release all such parties from any liability for any damages whatsoever that may result from their furnishing such information.

 

I understand that this application remains current for only 90 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

 

If I am employed, I understand that my employment will be at-will, and the employer reserves the right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

 

I understand that after an offer of employment, and prior to reporting to work, I will be required to submit to a drug screen. I may also be required to submit to a medical review. Depending on company policy and the needs of the assigned job, I may be required to complete a medical history form and may be required to be examined be a medical professional designated by the employer.

Please check the box below to certify that you have read and agree to the terms above and click Submit below to send your application

 

Please click SUBMIT below to send your nomination.