EMPLOYMENT HISTORY
List your full employment history, starting with your current or most recent employment, working backwards. Disclose reasonsf or gaps in employment.
Employer 1
Employer 2
Employer 3
Employer 4
Your Job Title
Company Name
Company City, State
Company Phone Number
Supervisor First and Last Name
Supervisor Title
List all Responsibilities
Reason for Leaving
Employer 5
Your Job Title
Company Name
Company City, State
Company Phone Number
Supervisor First and Last Name
Supervisor Title
List all Responsibilities
Reason for Leaving
ADD NEXT EMPLOYER
AUTHORIZATION
If you are a finalist and a conditional offer is made to you, the City may conduct pre-employment drug and job function testing, and will contact your supervisors to verify work performance, as well as conduct a pre-employment criminal background check and driver license check.
PRIVACY NOTICE : In accordance with the Minnesota Government Data Practices Act, the City of Moorhead is required to inform you of your rights pertaining to private data collected from you. Private data is that information which is available to you, but not to the public. Private data includes your address, phone number, email, birthday, gender and social security number. *Names of applicants remain private except when certified as eligible for appointment to a vacancy or when applicants are considered by the finalists for a position. “Finalist” means a person who is selected to be given an interview with the City Manager, or his/her designee, as a final step prior to selection. Public Data: The following are classified as public data under the Minnesota Government Data Practices Act M.S. 13.43, Subd 3. Veteran status, relevant test scores, rank on eligible list, job history, education and training, and work availability.
The information you provide on this application is needed to identify you and to assist the City of Moorhead, Human Resources Department and Supervisor in determining your suitability for the position for which you are applying. Additionally, data supplied by you may be used for such purposes necessary in the City’s administration of personnel and in the administration of policies, rules and regulations. You are not legally required to provide any of the information on this form. However, failure to provide complete, accurate information may result in the City being unable or unwilling to offer employment to you.
Before signing this application, read the following carefully.
1. I authorize all current and previous employers and references named to release job-related information including work performance, behavior, reason for leaving, hereby releasing those employers or individuals as well as the City of Moorhead from any liability.
2. I certify that the information contained in this application is true and complete. I understand that providing false information on this application may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired.
3. I understand that nothing in this employment application is intended to lead to or create an employment contract between the City of Moorhead and myself and no offer of employment will become final until formal approval by the appointing authority.
4. I certify that I have read (or had read to me) the information printed above and understand its meaning.
I agree that this form may be electronically signed and agree that my typed signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.
My typed signature signifies agreement to the above
* Signature (type full legal name)