APPLICATION FOR EMPLOYMENT Step 1 of 5 20% Position:(Required)Date Available For Work:(Required) MM slash DD slash YYYY Today's Date:(Required) MM slash DD slash YYYY Name:(Required) First Middle Last Address(Required) Street Address City State / Province / Region ZIP / Postal Code Telephone:(Required)Cell Phone:Email Address:(Required) Are you at least 18 years of age?(Required)YesNoAre you a United States Citizen and can you provide proof of citizenship?(Required)YesNoOR, do you have permission to work in this country?YesNoHave you ever been convicted of any crime, including sex-related or abuse related allegations, convictions, or pleading of guilty or "no contest"?(Required)YesNoHave you previously applied, been interviewed or been employeed by the Lake of the Woods School District?(Required)YesNoIf you answered yes to the previous question, please provide details (date/s and job title):Are you related to anyone currently working in any position (full-time, part-time, seasonal, temporary or appointed) for the Lake of the Woods School District?(Required)YesNoIf you answered yes to the previous question, please provide details (name and job title):HIGH SCHOOL INFORMATIONDid you graduate from High School or receive a GED?(Required)YesNoName of High School:High School Address: Street Address City State / Province / Region ZIP / Postal Code COLLEGE/UNIVERSITY INFORMATIONName of College/University:Dates of Attendence:Start Date & End DateCollege/University Address: Street Address City State / Province / Region ZIP / Postal Code Diploma/Degree Received:Major/Minor:G.P.A:COLLEGE/UNIVERSITY INFORMATIONName of College/University:Dates of Attendence:Start Date & End DateCollege/University Address: Street Address City State / Province / Region ZIP / Postal Code Diploma/Degree Received:Major/Minor:G.P.A:GRADUATE SCHOOLName of Graduate School:Dates of Attendence:Start Date & End DateGraduate School Address: Street Address City State / Province / Region ZIP / Postal Code Diploma/Degree Received:Major/Minor:G.P.A:TECHNICAL SCHOOLName of Technical School:Dates of Attendence:Start Date & End DateTechnical School Address: Street Address City State / Province / Region ZIP / Postal Code Diploma/Degree Received:Major/Minor:G.P.A: WORK EXPERIENCE #1List complete employment history, beginning with most recent first. Include paid and unpaid experiences. DO NOT USE "SEE RESUME" OR SIMILAR.Employer:Employer Phone:Employer Address: Street Address City State / Province / Region ZIP / Postal Code Supervisor's Name & Title:Position Held:Primary Responsibilities:Dates Employed (MO/YR):Start Date & End DateTotal (Years/Months):Hours Worked Per Week:Reason For Leaving:May We Contact Your Employer?YesNoIf We May Not Contact Your Employer, Indicate the Reason:WORK EXPERIENCE #2Employer:Employer Phone:Employer Address: Street Address City State / Province / Region ZIP / Postal Code Supervisor's Name & Title:Position Held:Primary Responsibilities:Dates Employed (MO/YR):Start Date & End DateTotal (Years/Months):Hours Worked Per Week:Reason For Leaving:May We Contact Your Employer?YesNoIf We May Not Contact Your Employer, Indicate the Reason:WORK EXPERIENCE #3Employer:Employer Phone:Employer Address: Street Address City State / Province / Region ZIP / Postal Code Supervisor's Name & Title:Position Held:Primary Responsibilities:Dates Employed (MO/YR):Start Date & End DateTotal (Years/Months):Hours Worked Per Week:Reason For Leaving:May We Contact Your Employer?YesNoIf We May Not Contact Your Employer, Indicate the Reason:WORK EXPERIENCE #4Employer:Employer Phone:Employer Address: Street Address City State / Province / Region ZIP / Postal Code Supervisor's Name & Title:Position Held:Primary Responsibilities:Dates Employed (MO/YR):Start Date & End DateTotal (Years/Months):Hours Worked Per Week:Reason For Leaving:May We Contact Your Employer?YesNoIf We May Not Contact Your Employer, Indicate the Reason: EMPLOYMENT INFORMATION (continued)Have you ever been dismissed or asked to resign from any employment?YesNoIf you have been dismissed/asked to resign, please provide details including the reasons and the employer(s) involved:Have you ever been refused employment?YesNoIf you have been refused employment, please provide details including the reasons and the employer(s) involved:Other Qualifications: Summarize other job-related skills and qualifications acquired from employment, education or volunteer experience.Is there any additional information you believe would be helpful when considering your application?REFERENCE #1Please list three supervisory references (not relatives) that you have worked for that can attest to your qualifications. Provide name, complete address, position held by the reference and telephone number including area code.Name:(Required)Position Held:(Required)Phone:(Required)Address: Street Address City State / Province / Region ZIP / Postal Code REFERENCE #2Name:(Required)Position Held:(Required)Phone:(Required)Address: Street Address City State / Province / Region ZIP / Postal Code REFERENCE #3Name:(Required)Position Held:(Required)Phone:(Required)Address: Street Address City State / Province / Region ZIP / Postal Code DRIVER'S LICENSE INFORMATIONA driver's license is a requirement for certain positions if a District vehicle is used. Please complete this supplement identifying current information regarding your driving privileges.State:(Required)License Number:(Required)Expiration Date:(Required) MM slash DD slash YYYY Class:(Required)ABCDList of Endorsements:Have you ever had a driver's license issued by another name?(Required)YesNoIf "Yes" provide name:Have you ever had a driver's license issued by another state?(Required)YesNoIf "Yes" provide details:Has your driver's license ever been suspended, revoked or placed on court probation by another state?(Required)YesNoIf "Yes" list and provide details:Do you have any restrictions on your license?(Required)YesNoIf "Yes" provide details:Have your driving privileges ever been denied, suspended or revoked?(Required)YesNoIf "Yes" provide dates and details:The Lake of the Woods School conducts driver's license checks and criminal history background checks on all regular full-time employees, part-time employees, temporary and seasonal employees. All Lake of the Woods School employees must maintain less than four (4) points on their evaluations to operate School District owned vehicles and equipment. 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 and 62). Generally, this includes child abuse crimes, murder, manslaughter, felony level assault or any assault 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. ELECTION OF VETERAN'S PREFERENCEMinnesota Statute 197.455Preference points are awarded to qualified veterans and spouses of deceased veterans to add to their application results. Points are awarded subject to the provisions of MN Statute 197.455. To be eligible for veteran's preference points you must: (1) Be separated 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 rated at 50% or more, incurred while serving on active duty, and be a citizen of the U.S. or resident alien; or be the surviving spouse of a deceased veteran or the spouse if a disabled veteran who because of the disability is not able to qualify. The information you provide on this form will be used to determine your eligibility for veteran's preference points. You are not required to supply this information. However, we cannot award veteran's points without the required documents. You must supply a copy of your DD214. Disabled veterans must also supply form FL-802 or an equivalent letter from a Service Retirement Board or the Department of Veteran's Affairs. Spouses applying for preference points must supply their marriage certificate, the Veteran's DD214 and FL-802 or death certificate.If you are a veteran, do you wish to claim veteran's preference?YesNoIf "yes", please check the preference you are claiming:5 - Veteran - Attach a copy of your DD21410 - Disabled Veteran - Must be disability rated at 50% or higher to receive points. Attach a copy of your DD214 and FL-802 (or an equivalent letter from a service retirement board) to receive 10 points.5 - Spouse of a deceased veteran. Attach a copy of your marriage certificate, the veteran's DD214 and the death certificate to receive 5 points.10 - Spouse of a disabled veteran who is unable to use preference due to diasbility. Attach a copy of your marriage certificate, the veteran's DD214 and FL-802 (or an equivalent letter from a service retirement board) to receive 10 points.DD214 FormMax. file size: 50 MB.FL-802 Form (or an equivalent letter from a service retirement board)Max. file size: 50 MB.NOTICE TO APPLICANTInformation requested on your application that is defined by State Statute as public may be released on request and includes job history, education and training, relevant test scores, rank on our eligibility list, Veteran's status, and work availability. Your name is private until you are certified as eligible for appointment to a position or are considered by the appointing authority to be a finalist for a position in public employment. Certain other information is private and may be released only to you or to government entities authorized access by law.NAME/SOCIAL SECURITY NUMBER (SSN)Used to identify you in relation to other applicants. You are legally required to provide your name, but not your SSN. Failure to provide this information may result in a delay in processing or rejection of your application.LICENSE INFORMATIONUsed to certify applicants for positions where State law requires appropriate license. You are legally required to provide the information. Failure to provide this information may result in rejection of your application.CITIZENSHIP STATUSUsed to certify applicants for work in the U.S. as determined by laws of the U.S. Department of Labor and the State of Minnesota. Failure to provide this information may result in rejection of your application.APPLICANT'S STATEMENTI certify that I have read the "Notice to Applicant", regarding the MN Data Practices Act, and understand my rights as a subject of data. I authorize that a transcript may be requested where necessary to verify any education record. I hereby expressly authorize the collection, use and release of any and all information concerning me, which relates to my employment. I hereby release the Lake of the Woods School District, with which I am seeking employment, from any liability which may result from releasing information requested. I also expressly authorize the release by my present and past employers, including its agents/employees of any and all information concerning my employment with them, in any form, oral or written, and I agree to hold harmless my present and past employers from any liability whatsoever arising out of its release of information pursuant to this release. I understand that if offered a position, I may be required to submit to and pass a drug and/or alcohol screen. I may be required to submit to and pass a background investigation, psychological examination, a physical examination and a physical ability test if related to the position for which I am applying. I hereby certify that all answers contained in this application are true and I agree and understand that any misrepresentation or omission of facts contained in this application will be grounds for disqualification for employment or in the event of employment, immediate dismissal from employment upon later discovery of any omission of facts or misrepresentations. By signing this form, I hereby acknowledge I have read and understood the above statements. Failure to sign this form may result in rejection of your application.Signature of Applicant:(Required)Date:(Required) MM slash DD slash YYYY CAPTCHA