Application
Title of Specific Position for which you are applying
Date of Application
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Month
-
Day
Year
Date
Date Available For Work
-
Month
-
Day
Year
Date
Name
First Name
Last Name
Are you 18 or older?
Yes
No
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you have relatives working for the city?
Yes
No
Employment Conditions Desired
Regular
Full Time
Temporary
Part Time
Have you previously been employed by the city?
Yes
No
Education
Did you graduate from high school or receive a GED?
Yes
No
How many years of education have you had?
Please list names and locations of colleges, universities, and technical schools you have attended and whether or not you graduated from these institutions
Certificate(s)/Degree(s)
Course Study
Employment History
Employment Firm
Company Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Phone
Please enter a valid phone number.
Your Title
Your Supervisor
Your Supervisors Title
Number and type of positions you supervised?
Principal Responsibilities – Be Complete
Employment Start Date
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Month
-
Day
Year
Date
Employment End Date
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Month
-
Day
Year
Date
Hours Per Week
Last Salary
Reason For Leaving
Employment History (2)
Employment Firm
Company Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Phone
Please enter a valid phone number.
Your Title
Your Supervisor
Your Supervisors Title
Number and type of positions you supervised?
Principal Responsibilities – Be Complete
Employment Start Date
-
Month
-
Day
Year
Date
Employment End Date
-
Month
-
Day
Year
Date
Hours Per Week
Last Salary
Reason For Leaving
Employment History (3)
Employment Firm
Company Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Phone
Please enter a valid phone number.
Your Title
Your Supervisor
Your Supervisors Title
Number and type of positions you supervised?
Principal Responsibilities – Be Complete
Employment Start Date
-
Month
-
Day
Year
Date
Employment End Date
-
Month
-
Day
Year
Date
Hours Per Week
Last Salary
Reason For Leaving
CLERICAL APPLICANTS ONLY, Word Processing/Computer Experience
Typing Speed
Number of Years
List of Software and Hardware
In accordance with the Immigration Reform and Control Act of 1986, the City of Pierz hires only U.S. citizens and lawfully authorized alien workers. If hired, you will be required to provide written documentation of citizenship or legalized alien program. Failure to provide said documentation will result in dismissal. Minn. Stat. Sec 518.611, Subd. 8. Requires employers to obtain information from all new employees regarding court ordered child support obligations that are required by law to be withheld from income. If hired, you will be required to provide such documentation. Failure to provide said documentation will result in dismissal. If you are hired for this position, you may be required to undergo a physical examination at this employer’s expense to determine whether or not you are able to perform the duties of this position in an effective and safe manner, and whether or not accommodations are necessary for you.
Give the names of four people other than relatives who can be contacted regarding your qualifications, work habits, and character.
Contact 1
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Position in relation to your work
Contact 2
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Position in relation to your work
Contact 3
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Position in relation to your work
Contact 4
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Position in relation to your work
The City of Pierz doe not discriminate on the basis of handicapped status in the admission or access to, or treatment or employment in, its programs or activities . It is the policy of the City of Pierz to provide reasonable accommodations to the known physical and mental limitations of qualified handicapped applicants and employees in order for them to perform the essential functions of the job in question. (If you need assistance in completing this application form, contact City Hall, 320-468-6471)
THE CITY OF PIERZ IS AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY EMPLOYER
The City has the right to verify information provided in the application. I may be discharged if there are any misrepresentations on this application or my resume or made by me in an interview which may be discovered now or anytime in the future. False information or misrepresentation may also subject me to the penalty provision of Minnesota Statutes 43A.39.
In connection with this application for employment, I authorize the City of Pierz and any agent acting on its behalf to conduct a inquiry into any job related information contained in this application including, but not limited to my records maintained by an educational institution relating to academic performance such as a transcript. Moreover I hereby release the City of Pierz and any agents acting on its behalf from any and all liability of whatsoever nature by reason of requesting such information from any person.
Yes
Yes, but not present employer until job is offered
No (We may be unable to hire you without this information)
Date
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Month
-
Day
Year
Date
Signature
Submit
Should be Empty: