Employment Application

Thank you for your interest in employment with CBH Cooperative. Please fill in the form below to apply for employment with us.

NOTE: Our organization does not discriminate on the basis of race, color, religion, national origin, sex, marital status, sexual orientations, and/or status with regard to public assistance, disability, age, or any other protected classification. CBH Cooperative provides reasonable accommodations to qualified applicants and employees with disabilities.

Submit Your Application

Fields marked (*) are required.

Personal Information
Full Name *
Address *
City *
State *
ZIP code *
Phone (with area code) *
Secondary/cell phone (with area code)
Have you ever been convicted of a felony? * Yes     No    
If yes, please explain
General Information
Position for which you are applying *
Date you can start working (mm/dd/yyyy) *
Salary/wage you are seeking *
Which work schedule are you willing to accept? * Full-time     Part-time    
Which shift time(s) would you prefer? Day     Evening     Night     Rotating     Split    
At which location are you interested in working? Belle Fourche     Sturgis     Union Center     Rapid City (propane only)     Hot Springs (propane only)    
If you are interested in Belle Fourche, in which departments are you interested in working? Convenience store     Lubricants     Travel center     Propane     Refined Fuels    
If you are interested in Sturgis, in which departments are you interested in working? Convenience store     Mr. Tire     Central office     Propane     Refined Fuels    
Have you previously applied at CBH? Yes     No    
Education and Training
What is the highest level of education you have completed? * GED     High school     College/Vocational Institution    
Name of high school
What is the highest grade level you completed in high school? 9     10     11     12    
Name of college/vocational institution
Course of Study
What is the highest grade level you completed in college/vocational institution? Freshman     Sophomore     Junior     Senior    
Degree, or certificate
Work History
Are you currently employed? * Yes     No    
If you are currently employed, may we contact your employer? Yes     No    
Name of current/most recent employer
Address of current/most recent employer
City of current/most recent employer
State of current/most recent employer
ZIP code of current/most recent employer
Job title for current/most recent employer
Date started for this employer (mm/dd/yyyy)
Date ended for this employer (mm/dd/yyyy)
Reason for leaving this job
How many other previous employers have you had? * None     One     Two     More than two    
Name of previous employer 01
Address of previous employer 01
City of previous employer 01
State of previous employer 01
ZIP code of previous employer 01
Job title for previous employer 01
Date started work for previous employer 01 (mm/dd/yyyy)
Date ended work for previous employer 01 (mm/dd/yyyy)
Reason for leaving previous employer 01
Name of previous employer 02
Address of previous employer 02
City of previous employer 02
State of previous employer 02
ZIP code of previous employer 02
Job title for previous employer 02
Date started work for previous employer 02 (mm/dd/yyyy)
Date ended work for previous employer 02 (mm/dd/yyyy)
Reason for leaving previous employer 02
Please summarize any other work history you have
References
First name of reference 01 *
Last name of reference 01 *
Phone (with area code) of reference 01. *
First name of reference 02 *
Last name of reference 02 *
Phone (with area code) of reference 02 *
First name of reference 03 *
Last name of reference 03 *
Phone (with area code) for reference 03 *
Additional Comments
Additional comments
Upload Your Resume
Upload your resume (PDF or MS Word format)

NOTE: Resumes are required only for professional positions. If you need assistance determining for what positions a resume apply, please contact us.


Agreement

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

I also authorize CBH Cooperative to make any investigation of my personal or employment history, and I also authorize any former employer, person, firm, corporation, or government agency to give CBH Cooperative any information they may have pertaining to me. In consideration of CBH Cooperative’s review of this application, I release CBH Cooperative and all providers of information from any liability as a result of furnishing and receiving this information.


Agreement Acknowlegment
Do you agree with the above statements? * Yes, I do