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Saint Peter welcomes you as an applicant for (City of Saint Peter)

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Date Received:
-------
Saint Peter welcomes you as an applicant for employment.
It is the policy
of
the City
of
Saint Peter to provide equal opportunity to all employees and
applicants for employment. The City
of
Saint Peter will not discriminate against
or
harass any
employee or applicant for employment because
of
race, color, creed, religion, national origin, sex, disability, age, marital status, sexual
·orientation,
or
status with regard to public assistance. Our employment decisions are made on the basis
of
individual ability and merit.
Upon request, accommodations will be provided to applicants
in
accordance with American with Disabilities Act (ADA). Please call
(507)
934--0663.
Applicant's
Last
Name
__________
First
_______
Middle
_____
_
Position
Applying
For:----------------------------
APPLICATION INSTRUCTIONS:
To ensure that your application will be accurately processed, please review the following:
(1) Please print or type when completing this form.
(2) Complete a separate application form for each position opening you apply for, following
instructions completely and signing your application where required.
(3) Be specific and complete when filling out the Employment History section. Application
forms that are incomplete will
be
removed from further consideration. If additional space
is needed to complete your employment history, you may make copies
of
that page. A
resume may be attached to the completed application.
(4) Applications must be received at City Hall by the advertised closing date. When the stated
deadline is past, all applications will
be
reviewed and evaluated to determine how well
each applicant is suited for the position opening.
(5) Interviews will be conducted by the appropriate department head. Others may be
involved as needed. After discussion, they will select the best applicant for the position.
(6) The City Administrator's Office will inform the successful applicant and arrange a starting
date. Applicants will be notified by mail that the position has been filled.
(7) The City
of
Saint Peter strongly encourages City employees to live within the City they
serve.
RETURN COMPLETED APPLICATION
FORM
TO:
City Administrator's Office
City
of
Saint Peter
227 South Front Street
Saint Peter, MN 56082-2538
Telephone: (507) 934-0663
it
If you have any questions concerning completion
of
your employment application or the
employment procedures for the City
of
Saint Peter, please call the City Administrator's Office.
The City
of
Saint Peter is an Equal Opportunity I Affirmative Action Employer
barbaral@saintpetermn.gov
t TENNESSEN WARNING
In
accordance with the Minnesota Government Data Practices Act, the City
of
Saint Peter is required
to
inform you
of
your rights as they relate to the private information collected from you. Private data
is
information that is available to you, but 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
Saint Peter.
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 list.
(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 other purposes as may be detennined to
be
necessary
in
the administration
of
personnel policies, rules, and regulations
of
the City
of
Saint Peter.
Furnishing social security numbers, date of birth (unless a minimum age is required), sex, age group,
and
disability data is voluntary, but refusal to supply other requested infonnation will mean that your
application for employment may not be considered.
Private data is available only to you, appropriate City employees, and others as provided by state and
federal law 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 that is not designated in this notice
as private data.
Except for race, sex, age, and disability data, the information you give us about yourself is needed to
identify you and to assist the Saint Peter City Administrator's Office
in
detennining your suitability for
the position for which you are applying. Race,
sex,
age, and disability data are used
in
summary fonn
by the City
of
Saint Peter to monitor protected class employment and to meet federal, state, and local
reporting requirements.
I declare that I have read and understand the information given above regarding the Minnesota Data
Practices Act.
Applicant's Printed Name:
--------------------------
Applicant's
Signature:(!)
------------------Date:
_____
_
click to sign
signature
click to edit
t PERSONAL INFORMATION
NAME I ADDRESS I PHONE:
Last Name: First Name: Middle:
~----------
--------
-------
Address:
----------------------------------
City:
_____________
State:
___________
Zip:--------
Email Address:
-------------
Te
I e
phone:-------------
Between hours
of
and
-----
Telephone:--------------
Between hours
of
and
Are
you
under 18 years of age? . . . . . . . . . . . . . . . . . . . .
..
. . . . . . . . . . . . . . . . .
.. ..
. .
..
. . . .
..
. . .
..
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . D
No
D Yes
If
so,
are you 16 years of age
or
older?............................................................................ D
No
D Yes
EDUCATION
Educational
Course
Level
of
Did you List Diploma
or
Institution
Name and Address
of
Institution (Major/Minor) Education
Graduate Degree Awarded
<Y/N)
High
School
College
College
other
(Specify)
DRIVER'S LICENSE
(Only complete
this
section
if
a
driver's
license
is
required
for
the
position
you
are
applying
for.)
Driver's License#
______________
License Class (A, 8,
C,
D)
____
_
State
in
which license is issued: Expiration Date:
________
_
OTHER LICENSES & CERTIFICATES
Please list any other licenses, registrations,
or
certifications that are required or pertinent to the position you are applying for.
If
this licensing, etc., is required for the position, and you fail to include a photocopy
of
it
with your application fonn, your name will
be removed from further consideration for the position.
If
this licensing is not required for the position, but you feel
it
is relevant
and may be
an
item for which we are awarding points, please indicate below for credit to be awarded.
Type of License or Certificate
Licensing Agency
Expiration License Number
Date
* * Attach a
copy
of
each license
or
certificate
**
t EMPLOYMENT HISTORY
• The City of Saint Peter uses a 100-point system to assign value to the experience and training that relates
most closely to the position you are applying for. Your experience and training will be scored using the
experience and training value system designed for this position. Those applicants (typically the top 6 to 8)
with the highest number
of
total points will
be
advanced for additional consideration.
•
In
order to receive the correct points and credit for the knowledge and skills you have acquired, it
is
absolutely necessary that you are specific when describing these skills. Do not use a single general
statement to describe the duties you have performed. List each major duty performed for each position
held within the past five years. Whether you are describing your experience as a clerical worker or a truck
driver, list each duty separately and be specific. Describe duties
in
specific terms, such as "performed
word processing using Word,"
or
"operated forklift, front end loader, and back hoe." Statements such as
"performed general clerical work" or "operated heavy equipment" are too general.
• Please
be
specific
in
stating the dates
of
employment and number of hours you worked per week for each
job experience indicated. We need this information to properly score your experience.
If
hours worked per
week vary, please use the average number of hours worked per week.
+ Complete the boxed in "Length
of
Employment" section only for positions held within the past five years,
but please do include all
of
your relevant work experience
in
the Employment History section.
+ Please give accurate and complete information. List your present or most recent experience first.
*DO
NOT MARK YOUR APPLICATION "Please see resume." *
PRESENT
OR
MOST RECENT EMPLOYER
Employer:
_______________
_
May
we
contact this employer? D
No
D Yes
Employer Address:
----------------------------
Employer Phone Number:
Supervisor's Name &
Title:---------------------------
Your Job Title:
--------------------------------
Aver
age
Number
of
Hours Worked per Week:
--------------------
Numbers
and
types
of
positions you supervised:
-------------------
~ur
Dutles
&~spon~bil~es:
_________________________
_
Dates of Employment:
If
less than 5 years
ago,
indicate dates
of
employment:
(month & year)
(month & year)
If more than 5 years ago, only indicate how long
you
worked there:
___
years
___
months
PREVIOUS EMPLOYER
Employer:
_______________
May we contact this employer? D No D Yes
Employer Address:
---------------------------~
Employer Phone Number:
Supervisor's Name & Title:
--------------------------
Your Job Title:
------------------------------
Aver age Number
of
Hours Worked per Week:
-------------------
Numbers and types
of
positions you supervised:
-------------------
Your Duties & Responsibilities:
-------------------------
Dates
of
Employment:
If
less
than 5 years ago, indicate dates
of
employment:
(month & year)
(month & year)
If
more
than 5 years ago, only indicate how long you worked there:
___
years
___
months
t PROFESSIONAL REFERENCES
List people who know you well, preferably from a work environment and not an acquaintance
or
relative.
Name.
_____________
_
Address
_______________
_
Home Phone
___________
_
Work Phone
___________
_
Occupation--------------
Name.
_____________
_
Address
_______________
_
Home Phone
___________
_
Work Phone
___________
_
Occupation--------------
Name
______________
_
Address
_______________
_
Home Phone
___________
_
Work Phone
___________
_
Occupation
_____________
_
PREVIOUS EMPLOYER
Employer:----------------
May we contact this employer? D
No
OYes
Employer Address:
----------------------------
Employer Phone Number:
Supervisor's Name &
Title:---------------------------
Your Job Title:
______________________________
_
Average Number
of
Hours Worked per Week: -
-------------------
Numbers and types
of
positions you supervised:
-----
-
--
-----------
Your Duties & Responsibillties:
________________________
~
Dates of Employment:
If less than 5 years ago, indicate dates
of
employment:
(month & year)
(month & year)
If more than 5 years ago, only indicate how long you worked there: _ _ _ years
___
months
PREVIOUS EMPLOYER
Employer:
________________
May we contact this employer? D No D Yes
Employer Address:
Employer Phone Number:
Supervisor's Name & Title:
---------------------------
Your Job Title:
--------------
-
----------------
Aver age Number
of
Hours Worked per Week:
----
- -
---
----------
-
Numbers and types
of
positions you supervised:
-------------
------
Your Duties & Responsibillties:
________________________
_
Dates
of
Employment:
If
less than 5 years ago, indicate dates
of
employment: to
----
---
---
----
(month & year)
(
mo
nth & year)
If more than 5 years ago, only indicate how long you worked there:
__
_ years
___
months
t CLAIM FOR VETERAN'S PREFERENCE
The .eligibility requirements for veteran's preference are listed below. Read them carefully to see
if
you qualify.
If
you do wish
to
receive preference, be sure to complete this section. Providing the information
in
this section is voluntary. You must do so
if
you wish
to obtain the preference.
Veteran
EligibilityforOpen Competitive Position
(10
Points)
Must be a U.S. Citizen or resident alien who has separated under honorable conditions:
( 1) After serving on active duty for
181
consecutive days, or
(2) By reason
of
disability incurred while serving on active duty.
Disabled
Veteran
Eligibility for
Open
Competitive
Position
(15
Points)
Must have a compensable service connected disability as adjudicated by the United States Veteran's Administration
or
by the
Retirement Board
of
the several branches
of
the armed forces and the disability must exist
at
the time preference is claimed.
Disabled
Veteran
Eligibility for Promotional Position
(5
Points)
Must, at the time
of
election to use preference, be entitled to disability compensation for a permanent service-connected disability rated
at 50%
or
more and the position for which you are applying must be the first promotion after entering public employment.
Eligibility
as
a
Spouse
of a
Deceased
or Disabled
Veteran
Must
be
a spouse
of
either a deceased veteran
or
the spouse
of
a disabled veteran who, because
of
a disability, is unable to qualify for
the particular position due to his/her disability and who would have or does meet the criteria for one
of
the above-listed preferences.
ALL APPLICANTS CLAIMING VETERAN'S PREFERENCE MUST ATTACH A COPY OF HIS/HER FORM DD214. FAILURE TO DO
SO
MAY RESULT
IN
LOSS
OF
VETERAN'S PREFERENCE ELIGIBILITY.
City
of
Saint Peter Veteran's Preference Claim Form
For
V.A.
Use
Only:
Is the veteran named below rated as having a compensable service-related disability?
D
No
D
Yes%
of
Disability
____
_
By
___________________
Date
_______
_
Name
of
Veteran (last - first - middle)
Name
of
Applicant -
if
different than veteran (last - first - middle)
Address
City
State Zip
Classification
To
Be
Completed
by
Veteran
or
Spouse
of Deceased Veteran
(1) Are you a U.S. Citizen
or
resident alien? ......................................................................................................................... 0
No
0 Yes
(2) Were you honorably discharged from military service? .................................................................................................... 0
No
0 Yes
(3) Were you separated from military service after serving active duty for
at
least
181
consecutive days? .......................... 0
No
0 Yes
(4)
Do
you currently have a compensable service-related disabi.lity? ....................... :-: ............. : ........................................... 0
No
0 Yes
(5) Are you currently receiving a monthly pension based exclusively on length
of
military service? ..................................... 0
No
0 Yes
(6) Branch
of
Service Date
of
Discharge Serial Number
________
_
Type
of
Separation Date
of
Entry--------
For
spouse
of
deceased veteran, date
of
death-------------
If
Spouse
of
Disabled
Veteran, please answer the following:
If spouse is disabled, please explain why your spouse does not qualify for this position:
----------------
Claim Number (if disabled)
State
Claim is Filed In
Signature
of
Veteran
t EMPLOYEE CERTIFICATION
(1)
(2)
(3)
(4)
Before
signing
this
application, please read the following waiver carefully.
I have
read
and
understand the job announcement for the position for which I am applying
and
certify that the answers given
in
this application are true
and
complete to the best
of
my
knowledge.
I authorize all current
and
previous employers
to
release job-related information upon the
written request
of
the City Administrator's Office. However, I understand that if,
in
the
Employment History section, I have answered
"No"
to
the question, "May we contact this
employer?," contact with the employer will not
be
made without my specific authorization.
I authorize the City Administrator's Office
to
verify
all
information on this application
to
determine whether or not I
am
qualified for the position for which I
am
applying.
I understand that providing false information
on
this application may result
in
dismissal from any
position gained
on
the basis
of
that false information.
Applicant's Printed Name:
--------------------------
Applicant's
Signature:®
------------------Date:
_____
_
t BEFORE YOU SUBMIT YOUR APPLICATION, HAVE YOU
.....
~ Thoroughly
read
this entire application with special attention to the Tennessen Warning?
~
Signed this application
in
all the required places? This application will not
be
accepted without
all
necessary signatures.
• Tennessen Warning
• Claim for Veteran's Preference, if applicable
• Employee Certification
~
Provided sufficient information
so
that proper credit for training
and
experience are given?
· ~ Completed the claim for Veteran's Preference if applicable
to
you? Also, a copy of your
Form
00214
must be submitted at the time of application to determine your eligibility for points.
~ Have
you
included copies
of
all required licensing and/or certifications?
01/16
click to sign
signature
click to edit
The City
of
Saint Peter needs your cooperation in the completion of this form . It will enable
the City to report accurate information to both the State and Federal governments.
t AFFIRMATIVE ACTION APPLICANT INFORMATION
To All Applicants:
The following information
in
no way affects you as
an
individual applicant. This information will
be
used
to
find out how effective our recruitment efforts are
in
reaching all segments
of
the population
and
in
validation
of
our selection methods. The information will
not
be maintained
in
personnel files
and
it will not be made available to any person involved
in
decisions affecting an individual's
appointment or promotion to a position. Although providing this information is voluntary, it is
important that all applicants answer these questions
so
that we may take steps to prevent
discrimination
in
the recruitment and selection of employees for public service.
Position
Applying
For:
Department:
-------------------------------~
Instructions: Check the choice that answers each
of
the following questions.
(1)
What sex are you?
O Male O Female
(2) Of the following, of what racial/ethnic group do you consider yourself?
American Indian/Alaskan Native
--
African American
--
Asian and Pacific Islander
--
--Spanish
or Mexican American
White
--
Other
--
-----------------~
(3)
Do
you have a disability? O No O Yes
(4) How did you learn about this job opening?
__
City Website
St. Peter Herald
--
--
Minority
or
Female Publication/Organization
School
--
--City
Employee
Minnesota Job Bank
--
Walk-
In
--
--
Posting
in
City Hall
__
League
of
Minnesota Cities Website
__
Other (be specific):
____________
_
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Completed 24 January 2021

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