2. CITY OF MOOSE LAKE: APPLICATION OF EMPLOYMENT

4. First Name
5. Last Name
7. Address1
9. Address2
11. City
12. State
13. Zip
15. Phone:
16. Email:
18. Are you legally eligible to work in the United States in the position you are applying for?

    1. Yes
    2. No

    (Proof of citizenship or work eligibility will be required as a condition of employment.)

19. Are you at least 18 years old?

    1. Yes
    2. No
23. Education Experience
25. What is your highest level of education?
    -- Select One --Grade SchoolHigh SchoolCollege/TechnicalGraduate School
26. Did you graduate from this level of education?

    1. Yes
    2. No
28. School Name:
29. School Address:
31. Course of Study
32. Degree (if applicable):
36. Employment Experience:

    List your present or more recent employer first. Please note "see resume" is not an acceptable response for any entries on this application. Resumes will only be considered in addition to, but not in lieu of, this application.

38. Company 1
39. Last Supervisor
41. Address1
43. Address2
45. City
46. State
47. Zip
49. Last Job Title:
50. Hours worked per week:
52. Start Date
    Start Date
53. End Date
    End Date
55. Reason for Leaving:
57. Describe your duties at this job:
59. May we contact this employer?

    1. Yes
    2. No
60. Employer phone:
62. Company 2
63. Last Supervisor:
65. Address1
67. Address2
69. City
70. State
71. Zip
73. Last job title:
74. Hours worked per week
76. Start Date:
    Start Date:
77. End date:
    End date:
79. Reason for leaving:
81. Describe your duties at this job:
83. May we contact this employer?

    1. Yes
    2. No
84. Employer Phone:
86. Company 3
87. Last Supervisor
89. Address1
91. Address2
93. City
94. State
95. Zip
97. Last job title:
98. Hours worked per week:
100. Start Date:
     Start Date:
101. End Date:
     End Date:
103. Reason for leaving:
105. Describe your duties at this job:
107. May we contact this employer?

     1. Yes
     2. No
108. Employer Phone:
110. *To detail additional employment experience, please attach a resume.
114. Describe any unsalaried or volunteer experience relevant to the position for which you are applying (you may exclude, if you wish, information which would reveal race, sex, religion, age, disability, or other protected status).
116. Did you serve in the U.S. Armed Forces?

     1. Yes
     2. No
117. Describe your duties:
119. Do you wish to apply for Veterans' Preference points? If you answered "yes," you must complete the application for Veteran's Preference points, and submit the application and required documentation to the City of Moose Lake by the application deadline of the position for which you are applying.

     1. Yes
     2. No
120. Veteran's Preference Form
122. Resume (Optional)
123. Cover Letter (optional)

125. By electronically signing this application form, I certify that all information I have provided in their application for employment is true and complete to the best of my knowledge. Any misrepresentation or omission of any fact in my application, resume or any other materials or during any interviews, can be justification for refusal of employment, or employed, will be grounds for dismissal, regardless of length of employment of when the misrepresentation or omission is discovered. <P>I acknowledge that I received a copy of the job description summary for the position(s) for which I am applying.<P>I am providing the City of Moose Lake authorization to verify all information I provided within this application, including contacting current or previous employers. However, I understand that if, in the Employment Experience section, have answered "no" to the question, "may we contact your employer?" contact with my employer will not be made without my specific authorization. <P>I further understand that criminal history checks may be conducted (after I have been selected for an interview, in the case of non-public safety positions) and that a conviction of a crime related to this position may result in my being rejected for this job opening. I also understand it is my responsibility to notify the City of Moose Lake in writing of any changes to information reported in this application for employment. 

127. Electronic Signature Agreement

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
129. Electronic Signature
Leave This Blank:


131. 1. Receive an email copy of this form.
132. Email address

     This field is not part of the form submission.

133. Submit

* indicates a required field