Application for Employment

1Application for Employment

2Affirmative 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
Position Applied For*
Full Name*
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Best time to call
: Hours
Minutes
Cell
Best time to call
: Hours
Minutes
Email Address*
Referral Source
- Advertisement
- Employee
- Relative
- Walk-in
Have you been employed by us before?*
- Yes
- No
If Yes, When?
Have you ever filed an application with us before?*
- Yes
- No
If Yes, When?
Date available for work*
MM slash DD slash YYYY
Type of employment desired*
- Full-Time
- Part-Time
- Temporary
Are you currently employed?*
- Yes
- No
Are you on lay‐off and subject to recall?*
- Yes
- No
Will you travel if job requires it?*
- Yes
- No
Do you possess a valid Minnesota Drivers License?*
- Yes
- No
If you are under 18, are you eligible to work?*
- Yes
- No
Are you legally eligible for employment in this country?*
- Yes
- No
(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.
Employer
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Immediate Supervisor and Title
Job Title
Starting Hourly Rate/Salary
Final Hourly Rate/Salary
Summarize the nature of the work performed and job responsibilities
Dates Employed From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Reason for Leaving
May we contact for reference?
- Yes
- No
- Later
Employer
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Immediate Supervisor and Title
Job Title
Starting Hourly Rate/Salary
Final Hourly Rate/Salary
Summarize the nature of the work performed and job responsibilities
Dates Employed From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Reason for Leaving
May we contact for reference?
- Yes
- No
- Later
Employer
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Immediate Supervisor and Title
Job Title
Starting Hourly Rate/Salary
Final Hourly Rate/Salary
Summarize the nature of the work performed and job responsibilities
Dates Employed From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Reason for Leaving
May we contact for reference?
- Yes
- No
- Later
Employer
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Immediate Supervisor and Title
Job Title
Starting Hourly Rate/Salary
Final Hourly Rate/Salary
Summarize the nature of the work performed and job responsibilities
Dates Employed From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Reason for Leaving
May we contact for reference?
- Yes
- No
- Later
Comments
(including explanation of any gaps in employment)
Skills and Qualifications
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
High School Name and Location
High School Grades Completed
- None
- 9
- 10
- 11
- 12
High School Diploma/GED
- None
- Diploma
- GED
High School Extracurricular Activities
Describe any skills, special training, apprentice, and extracurricular activities that relate to the position for which you are applying.
High School Honors
Describe any honors you have received.
Undergraduate College/University Name and Location
Undergraduate College/University Years Completed
- 0
- 1
- 2
- 3
- 4
Undergraduate College/University Degree
Undergraduate College/University Extracurricular Activities
Describe any skills, special training, apprentice, and extracurricular activities that relate to the position for which you are applying.
Undergraduate College/University Course(s) of Study
Undergraduate College/University Honors
Describe any honors you have received.
Technical/Graduate/Professional School Name and Location
Technical/Graduate/Professional School Years Completed
- 0
- 1
- 2
- 3
- 4
Technical/Graduate/Professional School Degree
Technical/Graduate/Professional School Extracurricular Activities
Describe any skills, special training, apprentice, and extracurricular activities that relate to the position for which you are applying.
Technical/Graduate/Professional School Course(s) of Study
Technical/Graduate/Professional School Honors
Describe any honors you have received.
Professional, trade, business or civic associations
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.)
Special accomplishments, publications or awards
List special accomplishments, publications, awards. (You may exclude memberships which would reveal, sex, race, religion, age, national origin, color, disability or other.)
Additional Information
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.
Name*
Phone Number*
Years Known*
Please enter a number from 0 to 120.
Name*
Phone Number*
Years Known*
Please enter a number from 0 to 120.
Name*
Phone Number*
Years Known*
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.
Signature*

Application for Employment

Applicant Information

Employment Section

Educational Background

References

Disclaimer and Signature

Affirmative Action Voluntary Information

Special Notice