Application for Employment

1General Information

2Employment History

3Veterans Preference & Skills Assessment

4Attachments & References

5Certificate of Authorization

Please fill out all information on the enclosed form. Remember to attach a resume and cover letter. Incomplete applications will not be considered.
Date*
MM slash DD slash YYYY
Name*
First Middle Last
Address*
Street Address City State 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.
Education
Click the + icon to add another line.
Name Location Type of Degree Major/Minor
List any relevant registrations, licenses or certifications you have.

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Work Experience: Starting with your present or most recent employer, list prior work history. Attach other pages as necessary.
Previous Employer 1
Previous employer name*
Address
Street Address City State ZIP Code
Your supervisor's name*
Supervisor's phone number
Start 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/accomplishments
May we contact your current and previous employers prior to a job offer?
- Yes
- No
- Notify me first
Previous Employer 2
Previous employer name*
Address
Street Address City State ZIP Code
Your supervisor's name*
Supervisor's phone number
Start 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/accomplishments
Previous Employer 3
Previous employer name*
Address
Street Address City State ZIP Code
Your supervisor's name*
Supervisor's phone number
Start 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/accomplishments
Provide explanation for any gaps in employment.

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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.
Phone
This field is for validation purposes and should be left unchanged.

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Previous Employer 1

Previous Employer 2

Previous Employer 3

Election of Veterans Preference

Computer Expertise

Expertise Checklist for position in which you are applying for.

Cover Letter, Resume & Writing Sample

References

Certificate of Authorization Statement

Please read carefully and sign below:

Equal Opportunity Employer

Data Practices

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