Fillable City Employment Application Application for Employment

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City Employment Application Application for Employment

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The City Employment Application Application for Employment form is 7 pages long and contains:

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  • 13 check-boxes
  • 170 other fields

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U.S.A. forms for City of Cannon Falls

BROWSE CITY OF CANNON FALLS (MN) FORMS

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1
The City of Cannon Falls is an equal opportunity/affirmative action employer and welcomes your application. It is the policy of the City of
Cannon Falls to avoid discrimination in the employment process on the basis of sex, age, race, color, creed, religion, national origin, sexual
orientation, or any other non-relevant personal characteristic. The information you are being asked to provide is defined to be Personnel
Data under the Minnesota Government Data Practices Act. Pursuant to the Data Practices Act, some of this information is classified as
"public data" and the remaining information is classified as "private data". Data classified as "public" can be released to any requestor. Data
classified as "private" may only be released with your consent. The purpose for gathering this information is to determine if you meet the
minimum qualifications for the position selection process. You are not required by law to provide the information being requested. Failure to
provide any information requested in this application form may cause you to be removed from consideration during the selection process.
Please use a typewriter, computer or print in black ink. Complete all blanks on this application, sign, and return to the City of Cannon Falls,
Attn: Personnel, 918 River Road, Cannon Falls, MN 55009. Attach additional sheets if necessary to fully answer the questions.
Position(s) applying for:
Date of application
Best number to contact you between 8am and 4pm
Home Work Cellular
Last name First name Middle name
Home Phone
Street Address
Work Phone
City, State, Zip Code
Cell Phone
Driver’s License Number State of Issue
Email Address
You would be interested in: Full-time Part-time Temporary
Instructions: Check the “yes” box to the right if each statement below is true about
you. Check the “no” box if the statement is not true about you.
Answer
Have you ever filed an application with us before? If yes, when: _________________
Yes No
Have you ever been employed by us before? If yes, when: ___________________
Yes No
Do you have any friends or relatives, other than spouse working here?
Yes No
Are you currently employed?
Yes No
May we contact your current employer?
Yes No
Are you prevented from lawfully becoming employed in this country because of Visa or
Immigration status? Proof of citizenship or immigration status will be required upon employment.
Yes No
Are you currently in a layoff status and subject to recall?
Yes No
Can you travel if a job requires it?
Yes No
Application for Employment
City of Cannon Falls
918 River Road
Cannon Falls, MN 55009
(507) 263-9300 (507) 263-5843 (FAX)
DATE & TIME RECEIVED:
2
MILITARY SERVICE
We follow the Veteran’s Preference law. This law provides a ten point preference to those applicants who have received an Honorable Discharge or
separation after serving 181 or more consecutive days in the military services for purposes other than training. Disabled veterans receive fifteen points if
supporting documentation is provided to validate their eligibility. If you meet the requirements, and you wish to exercise your Veteran’s Preference at
this time, please indicate so below. Veteran’s Preference may not be claimed by any veteran who is receiving, or is eligible to receive, a monthly
veteran’s pension benefit based exclusively on length of service. This law does provide preference points may be used by the surviving spouse of a
deceased veteran and by the spouse of a disabled veteran who because of the disability is unable to qualify.
PLACE OF ENTRY
(City/State)
DATE OF SEPARATION OR DISCHARGE
FROM ACTIVE DUTY
____________________________
MO DAY YEAR
TYPE OF SEPARATION
OR DISCHARGE
(Honorable, General, etc.)
BRANCH OF
SERVICE
TOTAL TIME OF ACTIVE DUTY
YEARS______ MONTHS_____
SERVICE CONNECTED
DISABILITY, IF ANY
(State type and percent.)
PRESENT RESERVE STATUS
MILITARY OCCUPATION
► I hereby elect to claim Veteran’s Preference in accordance with Minnesota State law for the current City of Cannon
hiring process for which I am applying: (If Requesting Veteran’s Preference, attach a copy of the
DD-214 form that shows your eligibility.)
Signature _____________________________________________________________ Date ______________________________________
Describe any job related training received in the United Stated military.
SCHOOLING
Instructions: List your high school or GED and all post-secondary schools you have attended, along with credits
obtained, and any degrees, certificates, or diplomas received, and the dates attended.
School
Location (City & State)
and Phone Number
Credits
Obtained
Degree, Certificate,
or Diploma Received
Dates
Attended
High School or GED
College or Other Post-Secondary School
College or Other Post-Secondary School
College or Other Post-Secondary School
3
Specialized training, apprenticeship, skills and extra-curricular activities.
EMPLOYMENT HISTORY
Important Instructions: List all jobs you have held, paid or volunteer, for the last ten (10) years. List
chronologically, beginning with your current or most recent position first. If you had any periods of no
employment lasting longer than 30 days, add a separate listing for that time period and explain.
List your employment by position. For example, if you spent three years as a receptionist and one
year as an accounts receivable clerk, all working for the same security company, you would have at
least two position listings for that employer.
We evaluate your entire work history when scoring your application. Each position may be worth
points, so please be complete. Please do not leave this section blank or refer to a resume. Only
work experience listed on this form and in this exact format will be counted. You may add
extra sheets, if necessary, but please make sure to include all the requested information.
Employer ________________________________________________
Address_________________________________________________
Phone Number ________________ Your Title__________________
Supervisor __________________ Supervisor’s Title ________________
Length of Position
From (month/year) _________
To (month/year) ____________
Total (years/months) _________
_____ Full Time _____ Part Time
Last Salary/Wage ____________
May We Contact This Employer?
______ Yes ______ No
Principle Duties or Responsibilities:
Reason for seeking new employment:
4
Employer ________________________________________________
Address_________________________________________________
Phone Number ________________ Your Title__________________
Supervisor __________________ Supervisor’s Title ________________
Length of Position
From (month/year) _________
To (month/year) ____________
Total (years/months) _________
_____ Full Time _____ Part Time
Last Salary/Wage ____________
May We Contact This Employer?
______ Yes ______ No
Principle Duties or Responsibilities:
Reason for seeking new employment:
Employer ________________________________________________
Address_________________________________________________
Phone Number ________________ Your Title__________________
Supervisor __________________ Supervisor’s Title ________________
Length of Position
From (month/year) _________
To (month/year) ____________
Total (years/months) _________
_____ Full Time _____ Part Time
Last Salary/Wage ____________
May We Contact This Employer?
______ Yes ______ No
Principle Duties or Responsibilities:
Reason for seeking new employment:
Employer ________________________________________________
Address_________________________________________________
Phone Number ________________ Your Title__________________
Supervisor __________________ Supervisor’s Title ________________
Length of Position
From (month/year) _________
To (month/year) ____________
Total (years/months) _________
_____ Full Time _____ Part Time
Last Salary/Wage ____________
May We Contact This Employer?
______ Yes ______ No
Principle Duties or Responsibilities:
Reason for seeking new employment:
5
List professional, trade, business or civic activities and offices held.
You may exclude membership that would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status.
Other qualifications.
Summarize special job-related skills and qualifications acquired from employment or other experience.
State any additional information that you feel may be helpful to us in considering your
application.
SIGNATURE
I certify that all of the statements and information provided by me in this application and in any
attachments are true, complete and correct to the best of my knowledge and belief, and are made in
good faith. I understand that any false information or omission of information from this application
may be cause for rejection, disqualification, or dismissal if employed.
__________________________________________________________ _______________________________
(Signature of Applicant) (Date)
AUXILIARY AIDS AND ASSISTANCE
If, due to a disability, you need assistance in completing an application or if you anticipate that you will need auxiliary aids or service
in the selection process, please notify Human Resources at (507) 263-9300.
Please submit this application and all requested attachments to:
City of Cannon Falls
Human Resources Department
918 River Road
Cannon Falls, MN 55009
Phone: (507) 263-9300
Fax: (507) 263-5843
6
Tennessen Warning
In accordance with the Minnesota Governmental Data Practices Act, the City of Cannon Falls is
required to inform you of your rights as they relate to the private information collected from you.
Private data is information, which is available to you, not the public. The personal information we
collect about you is private. Minnesota Statutes 13.04 and 13.43 are two sections that govern what
affects you as an applicant for employment with the City of Cannon Falls. All data collected is
considered private except for the following:
1. Your veteran’s status
2. Relevant test scores
3. Your rank on our eligibility test
4. Your job history
5. Your education and training
6. Your work availability
Your name is considered private information; however, if you are selected to be interviewed as a
finalist, your name becomes public information.
The data supplied by you may be used for such purposes as may be determined to be necessary in
the administration of personnel policies, rules and regulations of the City of Cannon Falls. Refusal to
supply requested information will mean that your application for employment may not be considered.
Private data is available only to you, to appropriate City employees, elected officials and others as
provided by state and federal laws, who have a bona fide need for the data. Public data is available
to anyone requesting it and consists of all data furnished in the application for employment, which is
not designated in this notice as private.
I declare that I have read and understand the information given above, regarding the Minnesota Data
Practices Law.
____________________________________________ __________________________
Applicant’s Signature Date
7
Equal Opportunity/Affirmative Action Data
As an employer with an Affirmative Action program, we comply with governmental regulations, including Affirmative Action responsibilities where they apply.
The purpose of collecting the data requested below is to comply with state and federal Equal
Opportunity Employment reporting and other legal requirements. It is for periodic government
reporting purposes only. This form will be filed separately from your application and will not be used
in our recruitment evaluation process. Inclusion or exclusion of data will not affect any recruitment
selection decisions.
Your cooperation in providing the data is voluntary.
Name: (Last, First, Middle)
Address:
City: State: Zip:
Position Applying For: Today’s Date:
Birth Date: (Month/Day/Year)
Check One: _____ Male _____ Female
Check One of the Following: (Ethnic Origin)
_____ White _____ Hispanic _____ American Indian/Alaskan Native
_____ African/American _____ Asian/Pacific Islander _____ Other
Check if any of the following are applicable:
_____ Disabled Individual _____ Veteran _____ Disabled Veteran
How were you made aware of this employment opportunity? Check all that apply.
Newspaper (provide name): ________________________________________
City of Cannon Falls Web Site: _____
League of Minnesota Cities Web Site: _____
City Employee (provide name): _____________________________________________
Other (provide source): _____________________________________________
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City Employment Application Application for Employment

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Completed 11 July 2020

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