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City of Orono Employment Application

2. 
3. Application for Employment
   City of Orono
   P.O.Box
   Crystal Bay, MN 55323
   (952) 249-4600
5. Title of Specific Position for Which You Applying
6. Date of Application
   Date of Application
7. Date Available for Work
   Date Available for Work
9. Contact Information:
11. First Name
12. Last Name
14. Address
16. City
17. State
18. Zip Code
20. Phone Number
21. Email Address
23. County of Residence
24. Are you 18 years of age or over?*

    1. Yes
    2. No
25. If not, state Date of Birth
27. Have you previously been employed by the City?

    1. Yes
    2. No
28. If yes, date
    If yes, date
29. Previous Position with the City of Orono
31. Driver's License Number
32. Driver's License Class
33. Driver's License State
35. Education:
37. Did you graduate from high school or receive a GED?*

    1. Yes
    2. No
38. School Attended
39. How many years of education have you had *
    -- Select One --7891011121314151617181920
41. Name and Location of College, University, Technical School
42. Did You Graduate?

    1. Yes
    2. No
43. Degree, Certificate - Course of Study
45. Name and Location of College, University, Technical School
46. Did You Graduate?

    1. Yes
    2. No
47. Degree, Certificate - Course of Study
49. Name and Location of College, University, Technical School
50. Did You Graduate?

    1. Yes
    2. No
51. Degree, Certificate - Course of Study
53. Work Experience (Experience and training ratings are determined by this information. Please be complete.) List your present or most recent experience first. Attach additional sheets if necessary.
55. Employing Firm
56. Phone Number
58. Address
60. City
61. State
62. Zip Code
64. Your Title
65. Supervisor
    Supervisor's Title
67. Number and Type of Positions You Supervised
69. Principal Responsibilities
71. Length of Employment
    Length of Employment Start Date

    —

    Length of Employment End Date
72. Hours Per Week
73. Last Salary
75. May we contact your present employer?

    1. Yes
    2. No
76. If No, Please explain
78. Reason for Leaving
80. Employing Firm
81. Phone Number
83. Address
85. City
86. State
87. Zip Code
89. Your Title
90. Supervisor
    Supervisor's Title
92. Number and Type of Positions You Supervised
94. Principal Responsibilities
96. Length of Employment
    Length of Employment Start Date

    —

    Length of Employment End Date
97. Hours Per Week
98. Last Salary
100. May we contact your present employer?

     1. Yes
     2. No
101. If No, Please explain
103. Reason for Leaving
105. Employing Firm
106. Phone Number
108. Address
110. City
111. State
112. Zip Code
114. Your Title
115. Supervisor
     Supervisor's Title
117. Number and Type of Positions You Supervised
119. Principal Responsibilities
121. Length of Employment
     Length of Employment Start Date

     —

     Length of Employment End Date
122. Hours Per Week
123. Last Salary
125. May we contact your present employer?

     1. Yes
     2. No
126. If No, Please explain
128. Reason for Leaving
130. Employing Firm
131. Phone Number
133. Address
135. City
136. State
137. Zip Code
139. Your Title
140. Supervisor
     Supervisor's Title
142. Number and Type of Positions You Supervised
144. Principal Responsibilities
146. Length of Employment
     Length of Employment Start Date

     —

     Length of Employment End Date
147. Hours Per Week
148. Last Salary
150. May we contact your present employer?

     1. Yes
     2. No
151. If No, Please explain
153. Reason for Leaving
155. The City of Orono will not discriminate against or harass any employee or applicant for employment because of race, color, creed, religion, national origin, sex, disability, marital status, or status with regard to public assistance.
157. List any relevant current professional memberships, registrations or licenses. Include date first issued.
159. Job Relevant Volunteer and Unpaid Work Experience
161. Kind of Volunteer Activity
162. No. Hrs Per Mo.
163. Dates
     Dates Start Date

     —

     Dates End Date
165. Major Responsibilities
167. Kind of Volunteer Activity
168. No. Hrs Per Mo.
169. Dates
     Dates Start Date

     —

     Dates End Date
171. Major Responsibilities
173. Kind of Volunteer Activity
174. No. Hrs Per Mo.
175. Dates
     Dates Start Date

     —

     Dates End Date
177. Major Responsibilities
179. Describe any additional experience or training that qualifies you for this job.
181. Additional Attachments
     Please attach additional documents such as work history, resume, etc. if applicable.
183. In accordance with the Immigration Reform and Control Act of 1986, the City of Orono 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.
185. MN 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. Failure to provide said documentation will result in dismissal.
187. Have you served a sentence in jail or prison or been convicted of a misdemeanor or felony for which a jail sentence could have been imposed?

     1. Yes
     2. No
188. You may answer "No" if the conviction or criminal records have been annulled, sealed, set aside, or purged, or if you have been pardoned pursuant to the law.

     1. Yes
     2. No
190. Yes If "Yes", please specify.
192. If you are hired for this position you may be required to undergo a physical examination at the City'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 need to be made for you.
194. The City of Orono does 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 Orono 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.
196. Did you serve in the military service of this country and separate under honorable conditions from any branch of the armed forces of the U.S. after having served on active duty for 181 consecutive days or by reason of disability incurred while serving on active duty?

     1. Yes
     2. No
198. If "Yes", indicate dates of military service.
     If "Yes", indicate dates of military service. Start Date

     —

     If "Yes", indicate dates of military service. End Date
199. If "Yes", are you a permanent resident of the State of Minnesota?

     1. Yes
     2. No
201. Describe your duties and any special training.
203. Give the names of three people outside of relatives who can be contacted regarding your qualifications, work habits, and character.
205. First Name
206. Last Name
208. Phone Number
209. Position and relation to your work
211. First Name
212. Last Name
214. Phone Number
215. Position and relation to your work
217. First Name
218. Last Name
220. Phone Number
221. Position and relation to your work
223. The City of Orono is an EQUAL OPPORTUNITY EMPLOYER
225. The City of Orono has the right to verify information provided in the application. False information may subject an applicant to the penalty provisions of M.S. 43A.39.
227. In connection with this application for employment, I authorize the City of Orono and any agent acting on its behalf to conduct an inquiry into any job-related information contained in this application, including, but not limited to, my records maintained by an educational institution related to academic performance such as transcripts. Moreover, I hereby release the City of Orono and any agent acting on its behalf from any and all liability of whatsoever nature by reason of requesting such information from any person.

     1. Yes
     2. Yes, but not present employer until job is offered.
     3. No (We may be unable to hire you without this information.
229. Electronic Signature Agreement

     I declare that any statement in this application or information provided is true and complete and hereby acknowledge that I have read and understand the information below.

     1. I agree.
231. Electronic Signature
232. Date
     Date
234. IMPORTANT FACTS ABOUT INFORMATION ON YOUR APPLICATION This application is to assist in the process of referring you for possible employment. Certain information requested on the application is private, that is, may be released only to you or to agencies where you may be considered for employment (to comply with M.S. 15.165, Subd. 2). If you are employed, the data will be available to the Department of Finance, the Internal Revenue Service, and the Social Security Administration for payroll and tax purposes. If you disagree with the data we have about you, you may notify the City.
236. Private Data
237. Why we Ask for it
238. Are You Legally Obligated to Provide it?
239. What May Happen if you Don't Provide it?
241. Social Security Number
242. To distinguish you from all other applicants, and to make processing more efficient.
243. No
244. In most cases, nothing. However, it will help to ensure that we do not confuse your records with those of others.
246. Date of Birth (Final applicants only)
247. To conduct check of criminal record for certain positions
248. No
249. Failure to provide information may be cause for rejecting an applicant.
251. Name (The names of finalists for a position are public information.)
252. To distinguish you from all other applicants.
253. Yes
254. Failure to provide information may be cause for rejecting an applicant.
256. Street Address (City and County of residence are public information.)
257. To be able to contact you to determine availability for interview.
258. No
259. We may not be able to employ you in certain jobs where you may be required to come to work on short notice.
261. Sex, Racial/Ethnic Group, Handicapped Status, Veteran Status
262. To be able to make Equal Opportunity reports as required by law.
263. No
264. We will not be able to determine whether our selection processes result in discrimination, or to take affirmative action in our hiring.
266. Conviction Record
267. To determine whether we may legally accept an application from you and determine whether your record may be a job-related consideration.
268. Yes
269. We will not be able to make determinations required by law.
271. All other information on the application is public, and may be given to anyone for any purpose.
Leave This Blank:


273. 1. Receive an email copy of this form.
274. Email address

     This field is not part of the form submission.

275. Submit

* indicates a required field