Form Center

2. 

3. Application for Employment

   City of Orono

   2750 Kelley Parkway

   Orono, MN 55356

   (952) 249-4600

5. We welcome you as an applicant for employment with the City of Orono. It is the City of Orono’s policy to provide equal opportunity in employment. The City of Orono will not discriminate on the basis of race, color, creed, age, religion, national origin, marital status, disability, sex, sexual orientation, familial status, status with regard to public assistance, local human rights commission activity or any other basis protected by law.
7. Please furnish complete information, so we may accurately and completely assess your qualifications. You may attach any other information which provides additional detail about your qualifications for employment in the position you seek. Please refer to the Applicant Data Practices Advisory for guidance regarding how your application information will be used, the consequences of providing or not providing your information, and more.
9. The City of Orono accommodates qualified persons with disabilities in all aspects of employment, including the application process. If you believe you need a reasonable accommodation to complete the application process, please contact our City Offices at 952-249-4600.
11. Contact Information:
13. First Name
14. Last Name
16. Address
18. City
19. State
20. Zip Code
22. Phone Number
23. Email Address
25. County of Residence
26. Driver's License Number
27. Driver's License Class
29. Job Position:
31. Title of Specific Position for Which You Applying
32. Date of Application
    Date of Application
33. Date Available for Work
    Date Available for Work
35. Are you legally eligible to work in the United States in the position for which you are applying? Proof of citizenship or work eligibility will be required as a condition of employment.

    1. Yes
    2. No
37. Are you 18 years of age or over?*

    1. Yes
    2. No
39. Have you previously been employed by the City?

    1. Yes
    2. No
40. If yes, date
    If yes, date
41. Previous Position with the City of Orono
43. Education:
45. Are you currently a full time student?*

    1. Yes
    2. No
47. Did you graduate from high school or receive a GED?*

    1. Yes
    2. No
48. School Attended
49. How many years of education have you had *
    -- Select One --7891011121314151617181920
51. Name and Location of College, University, Technical School
52. Did You Graduate?

    1. Yes
    2. No
53. Degree, Certificate - Course of Study
55. Name and Location of College, University, Technical School
56. Did You Graduate?

    1. Yes
    2. No
57. Degree, Certificate - Course of Study
59. Related Experience:
61. List any other courses, seminars, workshops, or training you have that may provide you with skills related to this position.
63. List any relevant current professional memberships, registrations or licenses.
    Include date first issued.
65. Work Experience:
    Experience and training ratings are determined by this information. Please be complete and list your present or most recent experience first.
67. Employing Firm
68. Phone Number
70. Address
72. City
73. State
74. Zip Code
76. Your Title
77. Supervisor
    Supervisor's Title
79. Number and Type of Positions You Supervised
81. Principal Responsibilities
83. Length of Employment
    Length of Employment Start Date

    —

    Length of Employment End Date
84. Hours Per Week
85. Last Salary
87. May we contact your present employer?

    1. Yes
    2. No
88. If No, Please explain
90. Reason for Leaving
92. Employing Firm
93. Phone Number
95. Address
97. City
98. State
99. Zip Code
101. Your Title
102. Supervisor
     Supervisor's Title
104. Number and Type of Positions You Supervised
106. Principal Responsibilities
108. Length of Employment
     Length of Employment Start Date

     —

     Length of Employment End Date
109. Hours Per Week
110. Last Salary
112. May we contact your present employer?

     1. Yes
     2. No
113. If No, Please explain
115. Reason for Leaving
117. Job Relevant Volunteer and Unpaid Work Experience:
119. Kind of Volunteer Activity
120. No. Hrs Per Mo.
121. Dates
     Dates Start Date

     —

     Dates End Date
123. Major Responsibilities
125. Kind of Volunteer Activity
126. No. Hrs Per Mo.
127. Dates
     Dates Start Date

     —

     Dates End Date
129. Major Responsibilities
131. Please attach additional documents such as work history, resume, cover letter, etc. If applicable:
133. Resume
134. Cover Letter
135. Work History
136. Other
138. Additional Information:
140. In accordance with the Immigration Reform and Control Act of 1986, the City of Orono hires 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. Failure to provide said documentation will result in dismissal.
142. MN Stat. Sec. 518A.52, Subd. 9, requires employers to obtain information from all new employees regarding court-ordered child support obligations that are required by law to be withheld from income. Failure to provide said documentation will result in dismissal.
144. Yes If "Yes", please specify.
146. If you are hired for this position you may be required to undergo a physical examination at the City's expense to determine whether or not you are able to perform the duties of this position in an effective and safe manner, and whether or not accommodations need to be made for you.
148. The City of Orono does not discriminate on the basis of handicapped status in the admission or access to, or treatment or employment in, its programs or activities. It is the policy of the City of Orono to provide reasonable accommodations to the known physical and mental limitations of qualified handicapped applicants and employees in order for them to perform the essential functions of the job in question.
150. Military Experience:
152. Did you serve in the military service of this country and separate 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 incurred while serving on active duty?

     1. Yes
     2. No
154. If "Yes", indicate dates of military service.
     If "Yes", indicate dates of military service. Start Date

     —

     If "Yes", indicate dates of military service. End Date
155. If "Yes", are you a permanent resident of the State of Minnesota?

     1. Yes
     2. No
157. Describe your duties and any special training.
159. Do you wish to apply for Veterans’ Preference points?

     1. Yes
     2. No

     If you answered “yes,” you must complete the application for Veterans’ Preference points, and submit the application and required documentation to the City of Orono by the application deadline of the position for which you are applying

     Veterans' Preference Form.

161. References:
     Give the names of three people outside of relatives who can be contacted regarding your qualifications, work habits, and character.
163. First Name
164. Last Name
166. Phone Number
167. Position and relation to your work
169. First Name
170. Last Name
172. Phone Number
173. Position and relation to your work
175. First Name
176. Last Name
178. Phone Number
179. Position and relation to your work
181. The City of Orono is an EQUAL OPPORTUNITY EMPLOYER
183. The City of Orono has the right to verify information provided in the application. False information may subject an applicant to the penalty provisions of M.S. 43A.39.
185. In connection with this application for employment, I authorize the City of Orono and any agent acting on its behalf to conduct an inquiry into any job-related information contained in this application, including, but not limited to, my records maintained by an educational institution related to academic performance such as transcripts. Moreover, I hereby release the City of Orono and any agent acting on its behalf from any and all liability of whatsoever nature by reason of requesting such information from any person.

     1. Yes
     2. Yes, but not present employer until job is offered.
     3. No (We may be unable to hire you without this information.
187. Authorization: Electronic Signature Agreement

     I declare that any statement in this application or information provided is true and complete and hereby acknowledge that I have read and understand the information below.

     1. I agree.
189. Electronic Signature
190. Date
     Date
192. IMPORTANT FACTS ABOUT INFORMATION ON YOUR APPLICATION This application is to assist in the process of referring you for possible employment. Certain information requested on the application is private, that is, may be released only to you or to agencies where you may be considered for employment (to comply with M.S. 15.165, Subd. 2). If you are employed, the data will be available to the Department of Finance, the Internal Revenue Service, and the Social Security Administration for payroll and tax purposes. If you disagree with the data we have about you, you may notify the City.
194. Private Data
195. Why we Ask for it
196. Are You Legally Obligated to Provide it?
197. What May Happen if you Don't Provide it?
199. Social Security Number
200. To distinguish you from all other applicants, and to make processing more efficient. Used for payroll taxes, insurance purposes, and retained in the employee's data record.
201. No
202. In most cases, nothing. However, it will help to ensure that we do not confuse your records with those of others and processing employee payroll.
204. Date of Birth & Driver's License
     (Final applicants only)
205. To conduct check of criminal record for certain positions
206. No
207. Failure to provide information may be cause for rejecting an applicant.
209. Name (The names of finalists for a position are public information.)
210. To distinguish you from all other applicants.
211. Yes
212. Failure to provide information may be cause for rejecting an applicant.
214. Street Address (City and County of residence are public information.)
215. To be able to contact you to determine availability for interview.
216. No
217. We may not be able to employ you in certain jobs where you may be required to come to work on short notice.
219. Sex, Racial/Ethnic Group, Handicapped Status, Veteran Status
220. To be able to make Equal Opportunity reports as required by law.
221. No
222. We will not be able to determine whether our selection processes result in discrimination, or to take affirmative action in our hiring.
224. All other information on the application is public, and may be given to anyone for any purpose.
Leave This Blank:


226. 1. Receive an email copy of this form.
227. Email address

     This field is not part of the form submission.

228. Submit

* indicates a required field