1General Information2Employment History3Veterans Preference & Skills Assessment4Attachments & References5Certificate of Authorization Please fill out all information on the enclosed form. Incomplete applications will not be considered.Date* MM slash DD slash YYYY Name* First Middle Last Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Email* Do you have the legal right to work in the United States?* Yes No Final confirmation of employment with RNDC is contingent upon timely completion of an Employment Eligibility Verification Form (FormI-9).Are you at least 18 years of age?* Yes No Do you have any relatives employed by/on the board/commission of the RNDC?* Yes No If yes, whom? Have you ever been dismissed or forced to resign a position?* Yes No How did you learn about this job for which you are applying?* Do you have a valid driver's license?* Yes No Have you ever been previously employed by RNDC?* Yes No If yes, date of hire/title Position Applying For* Available Start Date* MM slash DD slash YYYY Type of Employment you are Seeking* Full-time Part-time Temporary Education Background* Less than high school HS Grad Some college 2 year college Technical school Bachelor's Degree Some graduate school Master's Degree Doctorate Degree Indicate all levels of education you have completed.EducationClick the + icon to add another line.NameLocationType of DegreeMajor/Minor List any relevant registrations, licenses or certifications you have. Work Experience: Starting with your present or most recent employer, list prior work history. Attach other pages as necessary. Previous Employer 1Previous employer name* Address Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Your supervisor's name* Supervisor's phone numberStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Ending Salary* Job Title Reason for leaving* Provide a detailed summary below of all job duties/accomplishmentsMay we contact your current and previous employers prior to a job offer? Yes No Notify me first Previous Employer 2Previous employer name* Address Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Your supervisor's name* Supervisor's phone numberStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Ending Salary* Job Title Reason for leaving* Provide detailed summary below of all job duties/accomplishmentsPrevious Employer 3Previous employer name* Address Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Your supervisor's name* Supervisor's phone numberStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Ending Salary* Job Title Reason for leaving* Provide detailed summary below of all job duties/accomplishmentsProvide explanation for any gaps in employment. Election of Veterans Preference The RNDC awards Veterans Preference to qualied veterans and spouses of deceased veterans in accordance with MN Statutes, Section 197.455. Complete this section only if you are a veteran and claiming Veteran’s Preference. NOTE: If you elect to use Veteran’s Preference, you must provide a copy of your DD-214. Disabled veterans must also supply form FL-802 or an equivalant letter from Veteran’s Administration. The spouse of a deceased veteran must provide a death certicate along with other required eligibility papers. My supporting documentation: is attached will be submitted by the application deadline Type of preference you are claiming: Veteran Disabled Veteran Spouse of Deceased Veteran Spouse of Disabled Veteran Computer ExpertisePlease check the box next to all areas that you have experience in.Microsoft Word years of experience* Microsoft Excel years of experience* Microsoft Outlook years of experience* Microsoft PowerPoint years of experience* Microsoft Access years of experience* Expertise Checklist for position in which you are applying for.Please check the square next to all areas that you have experience in. Establishment and implementation of annual goals, strategies Working with local units of government Working with state and or federal programs Developing contract for services Development of Safe Routes to School Plans Development of County Hazard Mitigation Plans Grant Writing GIS Community strategic planning Capital improvement planning Environmental reviews Comprehensive planning and plan updates Telecommunication/broadband planning Business retention and expansion processes Community finance methods Loan fund management MN DEED Small Cities Development Program USDA Rural Development programs Survey development and analysis Renewable energy project development Transportation planning Meeting minutes Knowledge of basic office equipment, i.e., copiers, printers, fax machines Event planning Schedule coordination Social media experience Customer service skills Conflict resolution Multitasking abilities Word processing Data entry Constant Contact Multi-line telephone system Words per minute (WPM) Cover Letter, Resume & Writing SampleAttachmentsUpload digital files here to send along with your application. This includes cover letter and resume. If no digital copies are available, list those attachments below and submit them to our office. • Max File Size: 10 MB • Max Uploads: 3 • Allowed File Types: jpg, gif, png, pdf Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 10 MB, Max. files: 3. Other AttachmentsTo assist us in evaluating your application, please feel free to attach any additional information necessary to describe your full qualifications. Please list attachments below:ReferencesPlease provide at least four professional references we can contact prior to a job offer. Click the + icon to add another line.*Click the + icon to add another line.Name/RelationshipPhone Number Certificate of Authorization Statement Please read carefully and sign below: I understand that this employment application and any other documents presented to me in the course of applying for employment with RNDC are not contracts or promises of employment. If employed, I understand the duration, hours, nature, compensation and benefits of my employment may be changed and modified from time to time without limitation or condition. Employment is at will in nature, meaning that the RNDC or the employee may terminate employment at any time, with or without notice. I understand that if I am chosen as a finalist for this position a criminal background investigation, drivers record and credit check will be performed. I authorize RNDC to investigate all statements on this application, including work history and education. I authorize my previous employers and work references to release any and all personnel data, including performance evaluations and complaints against me, to the RNDC as it relates to my application for employment at RNDC. Specifically, I release and waive any and all claims, including but not limited to claims for defamation, libel and slander, that I may have against any such individual or company as a result of their compliance with RNDC's request for information. I authorize all schools, colleges, universities and other educational institutions I have attended to provide RNDC with all information which it seeks related to the dates of my attendance, the degrees I have earned, the courses I have taken, my grade point average and related matters. I waive and release any and all claims I may have against these institutions as a result of their compliance with RNDC' s request for information. I certify that the information I have provided in this application is true and correct to the best of my knowledge and belief. understand that any false statements or omissions in this employment application form, or made in the course of applying for employment with RNDC, may disqualify me for employment or cause my subsequent dismissal from employment. Applicant Signature* Today's Date* MM slash DD slash YYYY Anti-Spam Test * Equal Opportunity Employer The RNDC does not discriminate in employment and no question on this is used for the purpose of limiting or excluding any applicant's consideration for employment on the basis prohibited by local, state, or federal law. Data Practices In accordance with the Minnesota Government Data Practices Act, the RNDC is required to inform you of your rights as they pertain to the private information collected from you. Private data is that information which is available to you, but not to the public. The personal information we collect about you is private. The information collected from you or from other agencies or individuals authorized by you is used to determine your qualifications. You are not required to provide this information; however, it is necessary to determine if you are qualified for employment. If you do not supply the required information, the RNDC will not be able to consider you for employment. The use of the data we collect is limited to that necessary for the administration and management of the RNDC's employment practice. Persons or agencies with whom this information may be shared include: RNDC Executive Director, Finance Director, directors and supervisors in a department where the job openings occur. Unless otherwise authorized by state statute or federal law, other government agencies utilizing the reported private data must also treat the information as private. You may exercise your rights as contained in the Minnesota Government Data Practices Act. These rights include: the right to see and obtain copies of the data maintained on you; the right to be told the contents and meaning of the data; and the right to contest the accuracy and completeness of the data. To exercise these rights, contact the Executive Director of the RNDC. CommentsThis field is for validation purposes and should be left unchanged. Δ
