Kanabec County Employment Application

NOTICE TO THE APPLICANT

We welcome you as an applicant to the County of Kanabec. It is our policy to hire the most suitable person for the position. Kanabec County is a equal opportunity employer. Kanabec County will take Affirmative Action to insure that all employment practices are free of such discrimination.

DATA PRIVACY NOTICE

The information requested on this application is intended to be used by the County in determining suitability for employment for the position which you are currently seeking. You are not legally required to provide any of the information on this form at this time. However, failure to provide complete, accurate information may result in the County being unable or unwilling to offer employment to you. With respect to any special accommodations necessary for completing your application or the interview process, the County may be unable to provide the necessary accommodations if you do not provide the information in the contact or position information sections. The information on this application which is classified as private data under the Minnesota Government Data Practices Act will not be released outside the County without your consent except as necessary for tax purposes or as otherwise required by state or federal law.

Contact Information

  Middle Initial   
       

Line 2:

            Alternate Phone

Position Information


(Relevant to or required by the position, such as P.O.S.T license for Law Enforcement, CPR, etc.)

Are you 18 years of age or older?   No    Yes

Are you legally eligible to work in the United States? (Proof will be required on employment) No Yes

Have you ever applied to Kanabec County for work before?   No    Yes
     If yes, please provide dates and title of position

Have you ever worked for Kanabec County before?   No    Yes
     If yes, please provide dates and title of position

Do you have any special needs which may necessitate accommodations in the application/interview process?  No  Yes
     If yes, please describe the type of accommodation requested

Are you subject to a non-compete agreement by a present or former employer?    No    Yes

Is any additional information relative to a change of name or nickname necessary
  to enable a check on your work and educational record?    No    Yes
     If yes, please explain

Describe your computer software experience and/or any other training you have

Education

How many years of schooling have you had:

High School: Name and Location Did you graduate? No Yes

College / Technical School

School Name and Location No. of Years Did you Graduate If yes, your degree Your major or course emphasis GPA
 No
Yes
 No
Yes
 No
Yes
 No
Yes

Military

Branch of Service: Rank at Separation:

Duties in Service:

Military Service Schools:

Veteran Status

Are you an honorably discharged veteran or the armed forces of the United States or are you otherwise
  eligible to claim Veteran's Preference Points? Yes No

Are you the spouse of a deceased honorably discharged veteran or disabled veteran who is unable to work due to such disability? Yes No

Do you wish to claim Veteran's Preference Points? Yes No
If yes, you must complete and enclose the County of Kanabec "Claim for Veteran's Preference" form
     Forms are available on the web site or at the County Coordinator's Office

If you are a disabled veteran and wish to claim additional points Please check here:

Proof of applicable military status/eligibility, such as a DD214 form, will be required in order to claim credits. Please submit the "Claim for Veteran's Preference" and submit or attach a copy of your DD214. Your DD214 form must be submitted within five (5) business days.


Employment Information

Are you employed at present? No Yes

May we contact your present employer? No Yes
If no please explain:
(Please keep in mind that if a conditional offer is made your current employer will be notified)

Describe your experience below. List the most recent (or current) employer first, then the next most recent, and so forth (10 years minimum). Attach additional sheets if necessary.

Employer's Name:

Employer Address: City: State: Zip:

Job Title:

Dates Employed: From To:    Full Time     Part Time
Beginning Salary: Ending Salary:

Supervisor's Name: Supervisor's Telephone:

Nature of Duties:

Reason for Leaving:


Employer's Name:

Employer Address: City: State: Zip:

Job Title:

Dates Employed: From To:   Full Time     Part Time
Beginning Salary: Ending Salary:

Supervisor's Name: Supervisor's Telephone:

Nature of Duties:

Reason for Leaving:


Employer's Name:

Employer Address: City: State: Zip:

Job Title:

Dates Employed: From To:   Full Time     Part Time
Beginning Salary: Ending Salary:

Supervisor's Name: Supervisor's Telephone:

Nature of Duties:

Reason for Leaving:


Employer's Name:

Employer Address: City: State: Zip:

Job Title:

Dates Employed: From To:   Full Time     Part Time
Beginning Salary: Ending Salary:

Supervisor's Name: Supervisor's Telephone:

Nature of Duties:

Reason for Leaving:


Additional Comments:

 

CRIMINAL BACKGROUND INFORMATION

The County will request information regarding criminal history in the event that you become a finalist for the position which you are applying. For certain positions, criminal background information will be requested during the application stage. Further, the County may conduct a criminal background check on individuals upon making a contingent job offer. Please refer to the job description or other application material states that a criminal check will be conducted, no offer of employment shall become final until receipt of the results of the criminal background check from the BCA, the content of which is acceptable to the County, a formal approval by the appointing authority.

NOTES AND CONDITIONS

Each of the following items becomes part of your application record by you clicking yes below. Be sure to understand these notes and conditions before signing.

  1. I voluntarily give Kanabec County the right to make a thorough investigation of my past employment, agree to cooperate in such investigation, and authorize all prior employers to supply such information to the full extent allowed by law. This waiver releases former employees from any claims of defamation for releasing such information.
  2. I understand that Kanabec County may obtain an investigative consumer report of me.
  3. If offered employment, I understand that I will be required to follow the personnel policies, department rules, and directives of the County Board of Commissioners, and any offer of employment is contingent on my producing verification of my right to work in the United States.
  4. I understand that false or misleading information given in my application or interview(s) may result in disqualification or - in the event of employment - dismissal. I attest that the information provided in this application is true and correct to the best of my knowledge.
  5. I understand that Kanabec County does not discriminate on the basis of marital status; however, the County will not employ any person in a position where he or she will be supervised, or evaluated by, his or her spouse.
  6. I understand that some positions require pre-employment and future physical examinations. I consent to take the pre-employment physical examination, and such future examinations as may be required by Kanabec County at such times and places as the County may designate.
  7. This document shall not be construed as a contract or offer of employment. Any offer of employment that may result will be that of an at-will employee.
  8. Job offers are made by the Coordinator's Office only. No other employment offer is binding upon the County of Kanabec.
  9. Kanabec County reserves the right to change its policies or otherwise alter conditions of employment without notice as the county deems appropriate.

There is a grievance procedure available if you are not given proper consideration due to minority, disability or other protected status. Contact the County Coordinator's Office for information.

 I indicate that I understand and agree to the above notes and conditions.