Employment

Step 1 of 9

Personal Information
Date*
Month
Day
Year
Name*
First Middle Last Suffix
Address*
Street Address Address Line 2 City State ZIP Code
Social Security Number*
Phone*
Email*
Enter Email Confirm Email
Are You 18 Years or Older?*
- Yes
- No
Are you authorized to work in the US?*
- Yes
- No
Have you worked for Roughrider Disposal, LLC. before?*
- Yes
- No
Have you ever been convicted of or plead guilty or no contest to a felony?*
- Yes
- No
A "Yes" response will not necessarily disqualify a candidate from employment. The nature and seriousness of the offense, the date of the offense, the relevance of the offense to the specific position(s) and other factors will be considered.
Your highest academic level*

Safety Information & Training
MSHA 8 Hr. Refresher*
- Yes, I can provide proof of completion
- No, I cannot provide proof of completion
Date
Month
Day
Year
MSHA 24 Hr.*
- Yes, I can provide proof of completion
- No, I cannot provide proof of completion
Date
Month
Day
Year
OSHA 10 Hr.*
- Yes, I can provide proof of completion
- No, I cannot provide proof of completion
Date
Month
Day
Year
PEC*
- Yes, I can provide proof of completion
- No, I cannot provide proof of completion
Date
Month
Day
Year
List All Safety Training Received in the Last 5 Yrs. (Type and Date)
In case of an emergency notify*
First Last
Phone*

Upload: References
Accepted file types: docx, pdf, Max. file size: 15 MB.
Reference #1
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Reference #2
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Reference #3
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*

Employment History
Upload: Cover Letter
Accepted file types: docx, pdf, Max. file size: 15 MB.
Upload: Resume
Accepted file types: docx, pdf, Max. file size: 15 MB.

Please include: Company Name, Phone Number, Address, Supervisor's Name, Job Title, Starting Salary, Ending Salary, Responsibilities, Start Date, End Date, & Reason for Leaving.
Company #1
Company Name*
Phone
Address
Street Address Address Line 2 City State ZIP Code
Supervisor's Name
First Last
Job Title*
Starting Salary
Ending Salary
Responsibilities*
Start Date*
Month
Day
Year
End Date*
Month
Day
Year
Reason for Leaving*
May we contact your supervisor for a reference?*
- Yes
- No
Company #2
Company Name
Phone
Address
Street Address Address Line 2 City State ZIP Code
Supervisor's Name
First Last
Job Title
Starting Salary
Ending Salary
Responsibilities
Start Date
Month
Day
Year
End Date
Month
Day
Year
Reason for Leaving
May we contact your supervisor for a reference?
- Yes
- No
Company #3
Company Name
Phone
Address
Street Address Address Line 2 City State ZIP Code
Supervisor's Name
First Last
Job Title
Starting Salary
Ending Salary
Responsibilities
Start Date
Month
Day
Year
End Date
Month
Day
Year
Reason for Leaving
May we contact your supervisor for a reference?
- Yes
- No

Before Submitting*
I certify that all of the information I provided is true
I certify that my answers are true and complete to the best of my knowledge and authorize Roughrider Disposal, LLC. to verify their accuracy and to obtain reference information on my work performance, as well as conducting criminal background checks, pre-employment drug test, and checking driving records. I waive any action against Roughrider Disposal, LLC. based on statements made during these investigations.

If this application leads to employment, I understand that false or misleading information or any kind of omissions of facts called for on this application shall be considered sufficient basis for dismissal. I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of the Employer. I understand that any employment offered is for an indefinite duration and at will and that either I or the Employer may terminate my employment at any time with or without notice or cause.

I acknowledge that the conditional offer of employment I may receive is contingent on my satisfactory completion of this background check and drug test. If the results of the background check or the drug test determine that I do not fit the conditions for employment, the conditional offer is revoked and I no longer will be considered a qualified candidate for employment.
Signature*
Entering your name here is your signature of agreement on this application.
Date*
Month
Day
Year

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Call Us: 701.638.8053

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Hours

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Prairie Disposal

24/7



Chimney Butte Disposal

7:00am to 7:00pm - 7 days a week

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Smoky Butte Disposal

By Appointment Only. Please call Prairie Disposal for Scheduling.

Contact

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Office

(701) 638-8053

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Sales

sales@roughriderdisposal.com

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Accounts Payable/Receivable

accounts@roughriderdisposal.com

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Employment

Step 1 of 9

Personal Information

General Information

Equipment Operating Experience

Driving Record Information

Safety Information & Training

Reference #1

Reference #2

Reference #3

Employment History

Company #1

Company #2

Company #3

Drug Screening

Get Started Now

Hours

Prairie Disposal

Chimney Butte Disposal

Smoky Butte Disposal

Contact

Office

Sales

Accounts Payable/Receivable

Type of Equipment	Years of Experience