Name: DCI, Inc. Main Headquarters & Production Facility
Address: 600 North 54th Avenue, St. Cloud, MN
Telephone: 320-252-8200

Please fill out the form below to apply for a position with us.

Employment Application

DCI General Employment From

Step 1 of 5

Today's Date*
MM slash DD slash YYYY
Name*
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Are you 18 or Older?*
- Yes
- No
Are you Lawfully able to work in this country?*
- Yes
- No
Are you able to drive for work?*
- Yes
- No
Are you able to meet the attendance requirements for this job?*
- Yes
- No

EDUCATION

List

School Level	Name and Location	Number of Years Attended	Did You Graduate?	Subjects Studied

Areas of Special Study or Interest
Special Skills

US Military Service

Brance of Service	Rank	Present Member of National Guard or Reserves? (Yes or No)

EMPLOYMENT HISTORY

Please list your last 3 employers, within the past 5 years, start with the last employer first.

Dates Worked (D/M/Y - D/M/Y)	Name, Address and Phone Number of Employer	Position	Reason for Leaving

Which of these jobs did you like best?
What did you like best about this job?
REFERENCES

Please give the names of 3 people not related to you whom you have known for at least 1 year.

Name	Address and Phone Number	Business	Years Known

ACKNOWLEDGEMENT
Please read the following before clicking "I agree" below.
1. I acknowledge and certify that the information contained in this application is true and accurate to the best of my knowledge.
2. I give the Company full authorization on to verify any information contained in this application and authorize the Company to make any necessary inquiries regarding my character, reputation and abilities.
3. I fully release any individuals providing information to the Company regarding my character, reputation and abilities from and all liability regarding this information.
4. I acknowledge and understand that if any false information, inaccuracies, omissions, misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated based upon this discovery at any time.
5. I acknowledge and agree that if I am employed I will be expected to conform with any and all company rules, regulations, policies, and procedures, written or unwritten.
6. I acknowledge and agree that if I am hired, I will be considered an "at-will" employee and that my employment may be terminated at any time, with or without cause, with or without notice, by myself or by the company.
7. I acknowledge and understand that as a condition of employment I may be required to undertake a drug and alcohol test and/or a physical examination to determine if I am able to complete the essential functions of the job with or without accommodations.
8. I acknowledge and understand that this is an application for employment and not an offer or guarantee of employment.
9. I acknowledge and understand that any offer of employment will be based upon my ability to perform the essential functions of the job with or without reasonable accommodation, including and but not limited to: technical abilities, lifting requirements, driving ability, attendance expectations and attitude & behavior expectations.
Digital Signature*
I agree to the above and certify that all the information I have provided is correct.
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Employment Application

Step 1 of 5

EMPLOYMENT DESIRED

EDUCATION

EMPLOYMENT HISTORY

REFERENCES

ACKNOWLEDGEMENT

Employment Application

Step 1 of 5

EMPLOYMENT DESIRED

EDUCATION

EMPLOYMENT HISTORY

REFERENCES

ACKNOWLEDGEMENT

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