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List any other certificates, education or experience that you feel helps qualify you for the position.
If you are no longer employed here, please list reason for leaving employment.
Provide a brief description of the main job duties for this position.
If you are no longer employed here, please list reason for leaving.
Describe any unsalaried or volunteer experience relevant to the position for which you are applying (you may exclude, if you wish, information which would reveal race, sex, religion, age, disability, or other protected status).
Did you serve in the U.S. Armed Forces?
Do you wish to apply for Veterans' Preference points? (If you answered "yes", you must complete the Veterans' Preference application and submit with required documentation.)
I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for the rejection of my application and that if hired I may be released from employment. I acknowledge that I have received a copy of the job description summary for the position for which I am applying. With my signature below, I am providing the City of South St. Paul authorization to verify all information I provided within this application packet. I understand that the City of South St. Paul may require me to successfully complete a pre-employment drug and alcohol test and does require a background check as a condition of employment and that continued employment may be based on the successful completion of similar tests. Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information. I understand it is my responsibility to notify the City of South St. Paul in writing of any changes to information reported in this application for employment.
The information asked of you will be used to evaluate our overall efforts in reaching all segments of the population. The following information is VOLUNTARY and CONFIDENTIAL. This information NOT A PART of the application file and is REMOVED from the application when received by our office. The City of South St. Paul appreciates your cooperation in our efforts to ensure affirmative action and equal opportunity.
With which racial/ethnic group do you identify?
Do you claim disability status?
Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.White or Caucasian: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.Black or African American: A person having origins in any of the black racial groups of Africa.Native Hawaiian or Other Pacific Islander: A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.American Indian or Alaska Native: A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.Two or More Races: All persons who identify with more than one of the five races.
Veteran's Name (Last, First, Middle) exactly as it appears on Service Records
(DD214 must be submitted to receive points)
Please indicate percent of Disability. (DD214 and Letter from VA of proof of disability must be submitted to receive points.)
Indicate why the veteran is unable to work the specific position the spouse if applying for due to the nature of the veteran's service-connected disability rating of 10% or greater (be specific). (DD214 and Letter from VA verifying active duty disability related to the position requirements must be submitted to receive points.)
Please indicate Date of Death and whether you have remarried. (DD214, photocopy of marriage certificate and spouse's death certificate must be submitted to receive points. You are ineligible to receive points if you have remarried or were divorced from the veteran.)
Please indicate Date of Death and whether you have remarried. (DD214, letter from VA of proof of disability and USDVA proof that death was related to active duty injury, photocopy of marriage certificate and spouse's death certificate must be submitted to receive points. You are ineligible to receive points if you have remarried or were divorced from the veteran.)
Type full name.
This field is not part of the form submission.
* indicates a required field
