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Application for EmploymentLime Valley2019-10-29T11:13:28-05:00

Application for Employment

1 Application for Employment
2 Affirmative Action Voluntary Information
  • Please complete the application form as thoroughly as possible. Do not mark your application “see resume.” Resumes may be included, but will not be accepted in lieu of a completed application form. The information provided in the form will be used to assess your qualifications for the position. Applications and supporting documents must be received by the deadline date on the job posting.

  • Applicant Information

  • :
  • :
  • Date Format: MM slash DD slash YYYY
    (Proof of Citizenship or immigration status will be required upon employment)
  • Employment Section

  • List your last four (4) employers, assignments or volunteer activities, starting with the most recent, including military experience. Explain any gaps in employment in comments section below. You may exclude organizations which indicate race, color, creed, religion, national origin, sex, age, disability, sexual orientation, marital status or other protected status.

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • (including explanation of any gaps in employment)
  • Summarize any special training, skills, licenses, certificates and/ or characteristics of yourself that may qualify you as being able to perform job‐related functions for the position which you are applying.
  • Educational Background

  • Describe any skills, special training, apprentice, and extracurricular activities that relate to the position for which you are applying.
  • Describe any honors you have received.
  • Describe any skills, special training, apprentice, and extracurricular activities that relate to the position for which you are applying.
  • Describe any honors you have received.
  • Describe any skills, special training, apprentice, and extracurricular activities that relate to the position for which you are applying.
  • Describe any honors you have received.
  • List professional, trade, business, or civic associations and any offices held. (You may exclude memberships which would reveal, sex, race, age, religion, national origin, color, disability or other.)
  • List special accomplishments, publications, awards. (You may exclude memberships which would reveal, sex, race, religion, age, national origin, color, disability or other.)
  • List any additional information you would like us to consider.
  • References

    List name and phone number of three (3) business/work references who are NOT related to you. If not applicable, list three (3) school or personal references who are not related to you.
  • Please enter a number from 0 to 120.
  • Please enter a number from 0 to 120.
  • Please enter a number from 0 to 120.
  • Disclaimer and Signature

    • It is understood and agreed upon that any misrepresentation by me on this application or in my interview will be sufficient cause for cancellation of this application and/or separation from the employer’s service if I have been employed.
    • I give the employer the right to investigate all references and to secure additional information about me, if job‐related. I hereby release from liability the employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.
    • I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge the Employee at any time with or without cause.
    • This application is current for one (1) year. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application.
    • The employer is an Equal Opportunity Employer. The employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, state or federal law.
  • Affirmative Action Voluntary Information

  • We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, disability, veteran status or any other legally protected status.

    To be completed by applicant. Not for interview purposes. To be filed separately from application. This information is used to satisfy the Affirmative Action requirements of Section 503 of the Rehabilitation Act or as necessitated by another federal law or regulation.

    As required, we comply with government regulations including Affirmative Action obligations where they apply.

    In an effort to comply with requirements regarding government record-keeping, reporting and other legal obligations, we ask that you complete this applicant data survey. Your cooperation is appreciated.

    Please be advised that this survey is NOT a part of your official application for employment. It is considered confidential information that will not be used in any hiring decision.

  • Special Notice

    To Vietnam Era Veterans, Disabled Veterans and Individuals with physical or mental disabilities:

    Government contractors subject to the Vietnam Era Veterans Readjustment Act of 1974 and the Rehabilitation Act of 1973 are required to take affirmative action to employ and advance in employment qualified disabled veterans, veterans of the Vietnam era and qualified handicapped individuals.

    You are invited to volunteer this information, if you qualify, to assist in proper placement and determining reasonable accommodation. This information will be considered confidential. Refusal to provide this information will not adversely affect your consideration for employment.

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Main Office

Chippewa County
719 North 7th Street, Suite 302
P.O. Box 159
Montevideo, MN 56265
320-269-6578 or
800-292-5437

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Ortonville, MN 56278
320-839-2111

 

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Madison, MN 56256-0166
320-598-3027

 

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P.O. Box 321
Benson, MN 56215
320-842-8565

 

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Canby, MN 56220
507-223-5471

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