General Information Title Title of specific position for which you are applying.
Date of Application
Date Format: MM slash DD slash YYYY
Date Available for Work
Date Format: MM slash DD slash YYYY
Name
First
Middle
Last
Address
Email
Personal Phone
Business Phone
Are you under the age of 21? Date of Birth
Date Format: MM slash DD slash YYYY
Do you have relatives working for MWMO? Relative Relationship
Department
Employment Position Desired Have you been previously employed by the MWMO? Previous Position
Attach Cover Letter & Resume Cover Letter Resume Other: transcripts, letters, etc. Work Experience List your present or most recent experience first.
Do not include dates more than 10 years ago.
Employing Firm
Employer Address
Employer Phone
Position/Title
Number and Type of Positions You Supervised
Employed From
Date Format: MM slash DD slash YYYY
Employed To
Date Format: MM slash DD slash YYYY
Supervisor
Supervisor's Title
Last Salary
Hours per Week
Reason for Leaving
Principal Responsibilities
May we contact this employer? Do Not Contact: Please Explain
Employing Firm
Employer Address
Employer Phone
Position/Title
Number and Type of Positions You Supervised
Employed From
Date Format: MM slash DD slash YYYY
Employed To
Date Format: MM slash DD slash YYYY
Supervisor
Supervisor's Title
Last Salary
Hours per Week
Reason for Leaving
Principal Responsibilities
May we contact this employer? Do Not Contact: Please Explain
Employing Firm
Employer Address
Employer Phone
Position/Title
Number and Type of Positions You Supervised
Employed From
Date Format: MM slash DD slash YYYY
Employed To
Date Format: MM slash DD slash YYYY
Supervisor
Supervisor's Title
Last Salary
Hours per Week
Reason for Leaving
Principal Responsibilities
May we contact this employer? Do Not Contact: Please Explain
Education Did you graduate from High School or receive a GED? High School Attended
Education Completed Name and Location of College, University or Tech School
Qtr. or Sem. Hours
Did You Graduate?
Certificate or Degree
Course of Study
Name and Location of College, University or Tech School
Qtr. or Sem. Hours
Did You Graduate?
Certificate or Degree
Course of Study
Name and Location of College, University or Tech School
Qtr. or Sem. Hours
Did You Graduate?
Certificate or Degree
Course of Study
Name and Location of College, University or Tech School
Qtr. or Sem. Hours
Did You Graduate?
Certificate or Degree
Course of Study
Relevant Current Professional Memberships, Registrations or License. Include date issued
Volunteer Experience Job Relevant Volunteer and Unpaid Work Experience
Describe any additional experience or training that qualifies you for this job
Office Equipment, Word Processing and Computer Experience Hardware Experience be specific
Software Expereince be specific
Other
Driver's Information Driver's License Number
State
Class
Expiration
Date Format: MM slash DD slash YYYY
References Give the names of at least four people who can be contacted regarding your qualifications, work habits and character.
References Name, Present Address, Phone Number, Position and Relation to Your Work
Legal to Work Do you legally have the right to work in the United States? In accordance with the immigration reform and control act of 1986, the mwmohires 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.
Criminal Record Background Checks
The MWMO conducts criminal history background checks on all employees.
Candidates for positions working with children will not be selected if they have been convicted of any crime listed in the Child protection worker act (minnesota statutes 299c.61 & 62). Generally this includes child abuse crimes, murder, manslaughter, felony level assault or any crime committed against a minor, kidnapping, arson, criminal sexual conduct, and prostitution related crimes.
Before any applicant is rejected on the basis of criminal conviction, he or she will be notified in writing and will be given any rights afforded by Minnesota Statutes Chapter 364. This includes the right to show evidence of rehabilitation.
Accommodations Do you have any physical or health limitations that would require special or reasonable accommodations by the MWMO? Accommodations
Tenneseen Warning / Data Practices Notice to all Applicants The Minnesota government data practices act requires that you be informed of the purposes and intended uses of the Information you provided to the MWMO during the application process or during employment. Any information about Yourself that you provide will be used to identify you as an applicant and to assess your qualifications for employment with The MWMO. If you wish to be considered for employment, you are required to provide the information requested in the Application for employment. If you refuse to supply information requested by the MWMO, it may mean your application will not be considered.
You are hereby advised that, under Minnesota law, the following information given by an applicant is considered to be public: veteran status, relevant test scores, rank on our eligible list; job history; education and training; work availability.
As an applicant, your name is considered private until you are certified as eligible for appointment to a position or when Applicants are considered by the appointing authority to be finalists for a position with the MWMO. “finalist” means an Individual who is selected to be interviewed by the appointing authority prior to selection.
The data concerning you, which is placed in your application folder or in your personnel file and which is not listed as Public, is private. This private data will be shared with you and those members of the MWMO staff who need it to process the Application, update your personnel record, evaluate your work performance and if you are handicapped, provide the necessary accommodations. It may also be shared with the following: persons authorized to have access to the information under state or federal law; persons authorized by court order to have access to the information; and persons to whom you consent in writing to have access to the information.
With the exception of racial and ethnic data, the data you give us about yourself is needed to identify you and to assist determining your suitability for the position for which you are applying. Racial and ethnic data is used to monitor protected class employment and to meet federal, state, and local reporting requirements. Furnishing racial and ethnic data about yourself, as well as your social security number, is voluntary.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not, and is not intended, to be a contract for employment. In the event of employment, I understand that false or misleading information given in my application, or interview(s), may result in discharge. I understand also, that I am required to abide by all rules and regulations of the MWMO.
I certify that answers herein are true and complete to the best of my knowledge. I certify that I have read the “notice to application” regarding the Minnesota data practices act (MN statutes 1301-1390), and I understand my rights as a subject of date.
Consent
As an applicant for a position with the MWMO, I consent to the MWMO conducting a criminal history background investigation on me. I understand that the information I provide is classified as private. I consent to the release of the information I am providing in this background investigation form and any other information obtained as a result of this background investigation, as is necessary and appropriate, to the MWMO.
Type Your Name to Give Consent*
Signature I understand the MWMO has the right to verify information provided in the application. If there are any misrepresentations on this application or my resume or made by me in an interview, which may be discovered now or any time in the future, I may be discharged for cause without severance pay of any kind. False information or misrepresentation may also subject me to the penalty provisions of m.S. § 43a.39.
In connection with this application for employment, I authorize the MWMO and any agent acting on its behalf to conduct any inquiry into any job-related information contained in this application, including, but not limited to, my records maintained by an educational institution relating to academic performance (such as transcripts). Moreover, I hereby release the MWMO any agent acting on its behalf from any and all liability by reason of requesting such information from any person.
Authorization*
I declare that any and all statements in this application or information provided are true and complete and hereby acknowledge that I have read and understand the information contained herein.
Signature* Type your name to agree.
The MWMO does not discriminate on the basis of race, color, national origin, sex, religion, age, sexual orientation, familial status or disability in employment or the provision of services.
The MWMO does not discriminate on the basis of handicapped status in the admission or access to or treatment of or employment in, its programs or activities. It is the policy of the MWMO to provide reasonable accommodations to known physical and mental limitations of qualified handicapped applicants and employees in order for to perform the essential functions of the job in question.
The MWMO is an affirmative action equal opportunity employer.
Veteran's Preference Points Supplement Do you wish to apply for Veterans' Preference points? Information Regarding Claiming Veterans’ Preference
Preference points are awarded to qualified veterans as defined by Minn. Stat. § 197.477, and to certain spouses of deceased or disabled veterans subject to the provision of Minn. Stat. §§ 197.447 and 197.455.
The veteran must:
be a U.S. citizen or resident alien;
have received a discharge under honorable conditions from any branch of the U.S. Armed Forces; AND have either:
served on active duty for at least 181 consecutive days, or
have been discharged by reason of service connected disability, or
have completed the minimum active duty requirement of federal law, as defined by CFR title 38, section 3.12a, i.e., having fulfilled the full period for which a person was called or ordered to active duty by the United StatesPresident, or
certified service and verification of “veteran status” granted under U.S. PL 95-202 (38 U.S.C. § 106)
The information provided will be used to determine your eligibility for veterans’ preference points. You are required to supply the following information:
Attach a copy of the “Member Copy 4” of your DD214 or DD215, or other documentation verifying service, This copy must state the nature of discharge; i.e., honorable, general, medical, under honorable conditions.
Disabled veterans must also supply a Military/United States Department of Veterans’ Affairs Rating Decision that supports/verifies the fact that the injury was incurred while on, or as a result of, active duty service. Generally, disability incurred while on, or as a result of, active duty for training purposes does not quality for disabled veteran preference per Minn. Stat. §§ 197.455 and 197.447 if it was incurred prior to September 7, 1980.
A spouse of a deceased veteran, applying for preference points must supply their marriage certificate, the veteran’s “Member Copy 4” DD214 or DD215, or other documentation verifying service, a death certificate, verification of their marriage at the time of veteran’s death, and that the spouse has not remarried.
Thank you for your military service and for your interest in employment with the MWMO. Please contact our office at 612-782-3301 or your local County Veterans’ Service Office, if you have any questions regarding veterans’ preference.
COMPLETE THIS FORM ONLY IF YOU ARE CLAIMING VETERANS’ PREFERENCE
You must submit a PHOTOCOPY of your “Member Copy 4” of your DD214 or other documentation verifying service to substantiate the services information requested on the form. Claims not accompanied by proper documentation will not be processed. For assistance in obtaining a copy of your “member Copy 4” of your DD214, or other documentation verifying service, contact your County Veterans’ Service Office.
The MWMO operates under a point preference system, which awards points to qualified veterans to supplement their application. Ten (10) points are granted to non-disabled veterans on open competitive examinations; Fifteen (15) points are awarded if the veteran has a service connected compensable disability as certified by the U.S. Department of Veterans Affairs (USDVA).
To qualify for preference for a competitive exam , you must have earned a passing score and been separated under honorable conditions from any branch of the armed forces of the United States after having served on active duty for 181 consecutive days, or by reason of disability incurred while serving on active duty, or after having served the full period called or ordered for federal, active duty and be a United States citizen or resident alien. Veteran’s preference may be used by the surviving spouse of a deceased veteran, or have active military service certified under 38 U.S.C. § 106, and by the spouse of a disabled veteran who is unable to qualify because of the disability.
To qualify for preference on a promotional exam , a veteran must have earned a passing exam score and received a USDVA active duty service connected disability rating of 50% or more. For a promotional exam, a qualified disabled veteran is entitled to be granted five (5) points. Disabled veterans eligible for such preference may use the five points preference only for the first promotion after securing employment with the MWMO.
Claims must be made on the form below and submitted with your application by the application deadline of the position for which you are applying. If the “Member Copy 4” DD214, or other documentation verifying service, is submitted to our office separate from this sheet, please attach a note with it indicating the position for which you are applying and your present address.
Name
First
Middle
Last
Address
Phone
Position For Which You Applied
Closing Date
Date Format: MM slash DD slash YYYY
Are you a US Citizen or Resident? VETERAN (10 points):Honorably discharged veteran DISABLED VETERAN (15 points):Percent of Disability
Have you ever been promoted within the MWMO employment? SPOUSE OF DECEASED VETERAN (10 points or 15 if the veteran was disabled at time of death):Date of Death
Date Format: MM slash DD slash YYYY
Have you remarried? SPOUSE OF DISABLED VETERAN (15 points):Veteran is unable to qualify for this position because Be specific
AFFIDAVIT : I hereby claim Veterans’ Preference points for this examination and swear/affirm that the information given is true,
complete and correct to the best of my knowledge. I hereby acknowledge that I am responsible to obtain the required Veterans’ Preference verification documents and submit them to the MWMO by the required application deadline.Signature Type your name
Affirmative Action Information (voluntary) To All Applicants:
The information requested below will be used for statistical purposes only. It will enable us to evaluate our recruitment process in light of federal and state equal opportunity laws. Your cooperation is strictly voluntary. Your application will be reviewed whether or not you provide this information.
Thanks for your help!
Date
Date Format: MM slash DD slash YYYY
Position for which applying
Gender Prefer to self describe
Age
Ethnic Identification Do you have a disability that substantially limits basic work activities? Special Notice to Disabled Individuals If you are a disabled person, you are invited to volunteer information concerning any personal physical or mental
disability and your suggestions on how we may accommodate you
How did you learn about this job? 