Employment Application

1
An Equal Opportunity and Affirmative Action
Employer
Employment Application
We appreciate your interest in our organization.
Please answer all questions. We comply with state
and federal laws prohibiting discrimination in
employment because of race, color, creed,
religion, gender, national origin, disability,
marital status, age, status with regard to public
assistance, or membership or activity in local
commissions. Our policy prohibits discrimination
on the basis of sexual orientation or identity.
Upon request, this application will be provided
in alternative formats to individuals with
disabilities.
Please print clearly using black or blue ink, or
type.
Position for which you are applying
________________________________________________
Salary expectation ______________________________
________________________________ Personal
Information First Name _______________
Middle___________ Last Name ___________________
_____ Address____________________________________
____________________________________ City
_____________________________________
State_______ Zip Code_______________ Social
Security _____-____-_____ Home Phone
____________________________
Business Phone __________________________ E-mai
l_________________________ Cell
Phone_______________________________ Education
(Relevant transcripts/degree must be attached if
required for position.) Name
Location (City,State) Graduate
Degree Major High School/GED
YES NO _______________________
_______________________ ____ ____
_______________ ______________ Vocational/Tech
nical _______________________ ___________________
____ ____ ____ _______________
______________ _______________________
_______________________ ____ ____
_______________ ______________ College/Univers
ity _______________________ _____________________
__ ____ ____ _______________
______________ _______________________
_______________________ ____ ____
_______________ ______________ _______________
________ _______________________ ____
____ _______________ ______________
2
References List persons familiar with your work
or education experience, for example, list
supervisors, coworkers, or teachers. Full Name
Complete
Address Yrs Known Relationship
Phone ______________________
________________________ ________ _________
_____________ ______________________
________________________ ________ _________
_____________ ______________________
________________________ ________ _________
_____________ ______________________
________________________ ________ _________
_____________ Are you authorized to work in the
Unites States? ____ Yes ____ No If no, you will
be asked to present Form I-151, Form I-94 or
other form indicating you alien status. Are you
related by blood or marriage to any Minnehaha
Creek Watershed District Board member or
employee? ____ Yes ____ No Your response to
this question will be considered only in relation
to the Districts nepotism policy. Note We
may be unable to hire you without reference
information.
Veterans Preference application Proof You must
submit a DD-214 as proof of eligibility for
Veterans Preference at the time of application
in order to receive preference points. Such proof
must include conditions of and length of service.
In the case of a disabled veteran, a verification
of disability from the Veterans Administration
will be required. The spouse of a deceased
veteran must provide a death certificate long
with other required eligibility
papers. Eligibility To qualify for Veterans
Preference, you must have been separated under
honorable conditions from any branch of the armed
forces of the United States after having served
181 consecutive days of active duty, or have been
discharged for a service-connected disability and
be a U.S. citizen or legal resident alien. The
spouse of a deceased veteran of a disabled
veteran who, because of such disability, is not
able to earn a living, may also qualify. A
person eligible to receive a monthly veterans
pension based on length of service will not be
eligible for Veterans Preference. Please
complete the following if applying for veterans
preference Veterans Name
Active Service dates ___________________________
________________________ ______
__/__/____ to __/__/____ Last First MI Are
you now receiving or eligible to receive a
monthly veterans pension based on length of
service ____ Yes ____ No
If yes Claim ________________________
Current percent of disability ______ If spouse
of veteran, please complete the
following Veterans present occupation
__________________________________________________
_____________________ Veterans total employment
earning for the past 12 months
______________________ If spouse of deceased
veteran, please complete the following Date of
Death __/__/____ Have you remarried?
____ Yes ____ No
3
Employment History (Attach additional pages if
necessary.) List a complete account of all your
work experiences. First, state your present or
most recent employment. Evaluation of experience
and training is based on this information.
Indicate each promotional level of employment in
a separate block. Have you previously been
employed by the Minnehaha Creek Watershed
District? Yes No If yes, please
provide dates, position, and reason for
leaving Employer____________________________
____________________ Length of
employment__________ Address
_________________________________________________
From ___/___ to ___/___ Supervisor_____
__________________________________________
___ Full time ___ Part time (list
hrs.) Phone___________________ Title
_________________________ Ending
annual salary___________ Responsibilities______
__________________________________________________
________________________ ________________________
__________________________________________________
______________________________ Reason for
seeking other employment_________________________
____________________________________ May we
contact this employer____________________________
________________________________________ Employ
er_______________________________________________
_ Length of employment__________ Address
________________________________________________
_ From ___/___ to ___/___ Supervisor___
____________________________________________
___ Full time ___ Part time (list
hrs.) Phone___________________ Title
_________________________ Ending annual
salary___________ Responsibilities_____________
__________________________________________________
__________________ ______________________________
__________________________________________________
_________________________ Reason for seeking
other employment_________________________________
____________________________ May we contact this
employer_________________________________________
___________________________
4
Employer_________________________________________
_______ Length of employment__________ A
ddress __________________________________________
_______ From ___/___ to
___/___ Supervisor______________________________
_________________ ___ Full time ___ Part time
(list hrs.) Phone___________________ Title
_________________________ Ending annual
salary___________ Responsibilities_____________
__________________________________________________
___________________ _____________________________
__________________________________________________
__________________ Reason for seeking other
employment_______________________________________
________________________ May we contact this
employer_________________________________________
____________________________ Employer__________
______________________________________
Length of employment__________ Address
_________________________________________________
From ___/___ to ___/___ Supervisor_____
__________________________________________ ___
Full time ___ Part time (list hrs.) Phone_______
____________ Title _________________________
Ending annual salary___________ Responsibilitie
s________________________________________________
__________________________________ ______________
__________________________________________________
__________________________________________ Reason
for seeking other employment____________________
___________________________________________ May
we contact this employer_________________________
____________________________________________ Emp
loyer____________________________________________
____ Length of employment__________ Addr
ess _____________________________________________
____ From ___/___ to ___/___ Supervisor
_______________________________________________
___ Full time ___ Part time (list
hrs.) Phone___________________ Title
_________________________ Ending annual
salary___________ Responsibilities_____________
__________________________________________________
___________________ _____________________________
__________________________________________________
____________________________ Reason for seeking
other employment_________________________________
______________________________ May we contact
this employer____________________________________
_________________________________ Copy this
form and attach additional pages if needed to
list relevant employment history.
5
Complete if position requirement Licenses/Certi
fications/Registrations Drivers License Please
list (include lic , expiration date, etc.)
Valid Drivers license ___ Yes ___
No _____________________________________ State
____ Expiration Date _________ _________________
____________________ __________________________
_____ _____________________________________ Class
__ A __B __C __D _______________________________
______ CDL_________________________ Equipment
you competently operate _________________________
___________________________ ______________________
__________________________________________________
________ Computer experience (specify
hardware/software/language)_______________________
__________ _______________________________________
_________________________________________
List additional information relevant to
position Have your employment, volunteer,
and/or military service activities involved your
supervising other people? ___ Yes ___ No If
yes, explain the nature of your supervisory
experience if it is relevant to the position for
which you are applying. ________________________
__________________________________________________
_____________ ____________________________________
__________________________________________________
__________ _______________________________________
__________________________________________________
_______ Briefly describe examples that would
demonstrate your knowledge, skills, or abilities
for the competencies outlined on the position job
posting/description. (Attach additional pages if
necessary) Knowledge ___________________________
__________________________________________________
________ _________________________________________
__________________________________________________
_____ ____________________________________________
__________________________________________________
__ _______________________________________________
_________________________________________________
__________________________________________________
______________________________________________ Ski
lls _____________________________________________
_____________________________________________ ____
__________________________________________________
__________________________________________ _______
__________________________________________________
_______________________________________ __________
__________________________________________________
____________________________________ _____________
__________________________________________________
_________________________________ Abilities
__________________________________________________
______________________________________ ___________
__________________________________________________
___________________________________ ______________
__________________________________________________
________________________________ _________________
__________________________________________________
_____________________________ ____________________
__________________________________________________
__________________________ Other (e.g.
Professional organizations, publications)
__________________________________________________
_ ________________________________________________
________________________________________________ _
__________________________________________________
_____________________________________________ ____
__________________________________________________
__________________________________________
6
Understanding of Employment Terms Agreement I
understand my application for employment and
related documents become the property of the
Minnehaha Creek Watershed District, and
completion of the application by me does not
guarantee employment or obligate the Minnehaha
Creek Watershed District in any way. I certify
that the information provided by me in this
application, testing, or interview is accurate
and true. I understand that false information,
misrepresentation or omission of facts may be
sufficient cause, in and of itself, for rejection
of my application, or dismissal if I am hired,
whenever discovered. I authorize the Minnehaha
Creek Watershed District to investigate my past
employment and/or education history. I release
the Minnehaha Creek Watershed District from any
liability or damages arising from this
investigation. I authorize former employers,
schools, personal and professional acquaintances
to give the Minnehaha Creek Watershed District,
or its agents, information regarding my
character, ability, general reputation, personal
characteristics and past records and I release
these organization and individuals from any
liability or damages for issuing this
information. I agree that as a condition of
employment I may be required to pass any written,
oral and medical examinations appropriate for the
position for which I am applying. I understand
that an offer of employment made by the Minnehaha
Creek Watershed District may be contingent,
depending upon the position for which I am
applying, upon the successful completion of a
comprehensive drug test at a licensed
laboratory. If I am employed, I agree to abide
by all regulations and policies of the Minnehaha
Creek Watershed District. I have read and
understand the above conditions and hereby agree
to them. ________________________________________
_____________ __________________________ Appli
cant Signature Date