Employment Application
KMM Print Location

KMM Inc., is an Equal Opportunity Employer. We are committed to equal treatment of all employees without regard to race, national origin, religion, gender, age, sexual orientation, veteran status, physical or mental disability or other basis protected by law. KMM is committed to promoting and fostering a favorable work environment.

***PLEASE FILL OUT APPLICATION COMPLETELY AND THOROUGHLY***
 
PERSONAL INFORMATION
 
Last Name:*
First Name:*
MI:
Present Address/Box:*
City:*
State:*
Zip Code:*
Permanent Address/Box:
City:
State:
Zip Code:
Telephone #:*
Email:*
GENERAL INFORMATION
 
Position Applying For:* (Unsolicited applications will not be accepted)
 
Date you can start:
Salary or Wage Expected:
Check if you are willing to accept:
Facility Preference: (Rank in order of Precedence. 1-First Preference, 4 Least Prefered)
Dickinson:
Killdeer:
Halliday:
Hettinger:
Regent:
Are you over the age of 16 years?:
EDUCATION/TRAINING
 
 
Name and Location
Course of Study / Major
# of Years Completed
Diploma/Degree
High School
College
Graduate
Vocational
Special certificates/license(s)/equipment operated:
List any other skills/abilities/qualifications/hobbies which should be considered:
MILITARY INFORMATION
 
Are you a Veteran?:
Branch:
Dates of Service:
From:
To:
WORK HISTORY
 
Have you ever worked at KMM?:
If yes, please indicate dates of employment and position(s) held:
Are you presently employed?:
If yes, may we contact your present employer?:
PLEASE COMPLETE THE WORK HISTORY SECTION STARTING WITH YOUR PRESENT OR MOST RECENT JOB
(Please be as specific and accurate as possible.)
Company:
City:
State:
Supervisor:
Hours Worked Per Week:
Supervisor phone:
Wage:
Per
Job Title:
List specific tasks completed on the job:
Date Started: (Month/Year)
Date Ended: (Month/Year)
 
Machines/Equipment You Have Operated:
Reason for Leaving:

Company:
City:
State:
Supervisor:
Hours Worked Per Week:
Supervisor phone:
Wage:
Per
Job Title:
List specific tasks completed on the job:
Date Started: (Month/Year)
Date Ended: (Month/Year)
 
Machines/Equipment You Have Operated:
Reason for Leaving:

Company:
City:
State:
Supervisor:
Hours Worked Per Week:
Supervisor phone:
Wage:
Per
Job Title:
List specific tasks completed on the job:
Date Started: (Month/Year)
Date Ended: (Month/Year)
 
Machines/Equipment You Have Operated:
Reason for Leaving:

Please summarize any other work history you may have:
TECHNOLOGY KNOWLEDGE
Select the level of your knowledge in each application:
 
Application
Knowledge
Type of Software
Word Processing
Powerpoint
Spreadsheet
Dynamics GP
Database
AutoCad
Charting Software
Programming
Other (list in Software Column):
PERSONAL BACKGROUND: DUE TO CONTRACT REQUIREMENTS, ALL EMPLOYEES MUST BE A U.S. CITIZEN OR HAVE A PERMANENT RESIDENCY (GREEN CARD) STATUS
The following questions can be answered with a yes or no. Further explanation may be requested.
 
Are you a US citizen?:
If you are not a US citizen, are you a permanent resident?:
Have you ever been convicted of a felony?: If so, when?
Have you ever been disciplined for fighting, assaults, or related behavior?:
Describe:
Have you ever been discharged or disciplined for violating safety rules?:
Have you ever been disciplined for any form of harassment or discrimination?:
WORK REFERENCES
Please list below three individuals who can provide work references (i.e. past employers/professional)
 
Name
Address
Telephone #
PLEASE READ *(Check box below upon agreement)*
  • KMM is an Equal Opportunity Employer M/F/D.
  • KMM is a drug-free employer.
  • Employees are hired on an employment-at-will basis.
  • This application is not a contract or guarantee of employment.
  • By completing the application, the applicant represents that all information presented in the application is complete and accurate.
  • If information in the application is found to be false or to have been intentionally omitted, adverse employment action, including termination, may occur.
  • KMM prohibits smoking within 25' of all facilities and has a smoke-free and tobacco-free environment.
  • Applications are not held for more than 30 days.
*
Date:*
Signature of Applicant:*
AFFIRMATIVE ACTION VOLUNTARY INFORMATION
We consider all applications for positions without regard to race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve/national guard or any other similarly protected status. We also comply with all applicable laws governing employment practices and do not discriminate on the basis of any unlawful criteria.
 

Not for interview purposes. To be completed by applicant on a voluntary basis.

In an effort to comply with requirements regarding government record keeping, reporting and other legal obligations which may apply, we invite you to complete this applicant data survey. Providing this information is STRICTLY VOLUNTARY. Failure to provide it will not subject you to any adverse personnel decision or action. Your cooperation is appreciated. Please be advised that this survey is not a part of your official application for employment. It will not be used in any hiring decision. The information will be used and kept confidential in accordance with applicable laws and regulations.

Referral Source:
Source Indicated:
Gender:
Please select one of the following Equal Employment Opportunity Identification Groups:
THANK YOU, KMM appreciates your time and effort in filling out this application in a complete and thorough manner.