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Position Information
Position Applied For*
Location Applied For*
Personal Information
Salutation*
Name*
First Last
Address*
Street Address City State ZIP Code
Business Phone
Home Phone
Cell Phone*
Email*
May we correspond with you through email?

Employment Information
Are you legally eligible for employment in the United States?*
Are you a current NDUTIME Employee or have you worked for NDUTIME in the past?*
If yes, then when?
What department?
Your name when employed by NDUTIME (if applicable)?
First Last
Please list any relatives employed by NDUTIME
License Information
Do you have a valid drivers license?*
License ID Number*
Do you have a commercial drivers license?*
Issuing State*
Expiration Date*
Month
Day
Year
List CDL Endorsements (if any)?
Additional Information
Have you ever been convicted of a felony?*
Misdemeanor? Any traffic infraction (moving violation)?*
If yes, please explain and provide dates

A conviction does not automatically eliminate you from employment consideration. The nature of the offense, when it occurred, and your truthfulness may be taken into consideration.
Have you ever been fired or asked to resign from a job?
If yes, give date(s), name and address of employer, and reason

A firing or forced resignation does not automatically eliminate you from employment consideration. The circumstances, time elapsed, and employment record may be considered. However, failure to be completely truthful and accurate about such circumstances may cause you to be disqualified from employment consideration.

Education History
Name of School
Address
Street Address City State ZIP Code
Type of School
Beginning Date
Month
Day
Year
Ending Date
Month
Day
Year
Years Completed
Major / Degree
Did you graduate?
Name of School
Address
Street Address City State ZIP Code
Type of School
Beginning Date
Month
Day
Year
Ending Date
Month
Day
Year
Years Completed
Major / Degree
Did you graduate?
Name of School
Address
Street Address City State ZIP Code
Type of School
Beginning Date
Month
Day
Year
Ending Date
Month
Day
Year
Years Completed
Major / Degree
Did you graduate?
Name of School
Address
Street Address City State ZIP Code
Type of School
Beginning Date
Month
Day
Year
Ending Date
Month
Day
Year
Years Completed
Major / Degree
Did you graduate?

Work History
Give a complete record of your employment history including part-time work military service, and volunteer experience. List all experience in order, starting with your present or most recent position and working back.
Beginning Date
Month
Day
Year
Beginning Date
Month
Day
Year
Name of Employing Firm
Address
Street Address City State ZIP Code
Immediate Supervisor
First Last
Title
Phone
Position Held
Starting Salary
Ending Salary
If part-time, list hours per week
Pay Basis
Your name while employed (if different)
First Last
Number and Title of people supervised
Description of Duties
Equipment Used
Beginning Date
Month
Day
Year
Ending Date
Month
Day
Year
Name of Employing Firm
Address
Street Address City State ZIP Code
Immediate Supervisor
First Last
Title
Phone
Position Held
Starting Salary
Ending Salary
If part-time, list hours per week
Pay Basis
Your name while employed (if different)
First Last
Number and Title of people supervised
Description of Duties
Equipment Used
Beginning Date
Month
Day
Year
Ending Date
Month
Day
Year
Name of Employing Firm
Address
Street Address City State ZIP Code
Immediate Supervisor
First Last
Title
Phone
Position Held
Starting Salary
Ending Salary
If part-time, list hours per week
Pay Basis
Name while employed (if different)
First Last
Number and Title of people supervised
Description of Duties
Equipment Used

Skills Inventory
Number of words per minute (typing)
Number of word per minute (standard)
May we contact your previous employers?
If no, when?
Month
Day
Year
Use this space for any special qualifications you may have relevant to the position for which you are applying
Please list your professional memberships
Please list your professional certificates, designations, licenses, honors, awards, fellowships, etc.
The statements made by me in this application are true and complete to the best of my knowledge. I understand that any willful misstatements or material omissions in this application will be sufficient cause to disqualify me from employment consideration with NDUTIME Youth & Family Services, Inc. If such misstatements or omissions are found after employment, it will be considered grounds for dismissal.

I understand that this completed application and any materials submitted with it are the property of NDUTIME Youth & Family Services, Inc. and will not be returned. In the case of a panel interview, which may consist of non-NDUTIME employees, I authorize my application to be viewed by members of the panel.

I also understand that any offer of employment is contingent upon my ability to produce documentation as required by the Immigration and Naturalization Service documenting eligibility for employment. Further, some positions may require drug/alcohol testing before and/or after employment.

I authorize the release of any and all job-related information that NDUTIME Youth & Family Services, Inc. may request or any records pertaining to past or present employment which may now exist or in the future exist.
By signing below, I certify that I have read and agree with these statements.*
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Apply Online

Step 1 of 5

Position Information

Personal Information

Employment Information

License Information

Additional Information

Education History

Work History

Skills Inventory