• Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Additional Education Information

  • Work History

    List complete employment history, beginning with most recent. Include paid and unpaid experience. DO NOT USE “SEE RESUME” OR SIMILAR.
  • EMPLOYER #1

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • List Principle Responsibility and the % of Time Spent for the Responsibility
  • EMPLOYER #2

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • List Principle Responsibility and the % of Time Spent for the Responsibility
  • EMPLOYER #3

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • List Principle Responsibility and the % of Time Spent for the Responsibility
  • EMPLOYER #4

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • List Principle Responsibility and the % of Time Spent for the Responsibility
  • EMPLOYER #5

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • List Principle Responsibility and the % of Time Spent for the Responsibility
  • References

    List three references you have known at least one year who can attest to your work qualities.
  • Reference #1

  • Reference #2

  • Reference #3

  • Veteran’s Preference Points

    Eligibility & Instructions
  • Preference points are awarded to qualified veterans and spouses of deceased or disabled veterans to add to their training and experience points. Points are awarded subject to the provisions of Minnesota Statutes §43A.11. To be eligible for veteran’s preference points, you must:

    Be separated under honorable conditions from a branch of the armed forces of the United States after having served on active duty for 181 consecutive days or by reason of disability incurred while serving on active duty, and be a citizen of the United States or resident alien; or be the surviving spouse of a deceased veteran (as defined above) or the spouse of 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 required to supply the information, but we cannot award points without it.

    Instructions:

    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. Spouses applying for preference points must supply their marriage certificate, the veteran’s DD214, and the FL-802 or death certificate.

    If you do not include these documents with this application, be sure to include your name and the name of the position for which you are applying when you do submit the documents. All documents must be received no later than seven (7) calendar days after the application deadline for the position for which you are applying

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • AN EQUAL OPPPORTUNITY EMPLOYER, the City of Madelia will hire and promote without regard to such non-job related distinctions such as race, creed, color, age, religion, sex, marital status, status with regard to public assistance, national origin, physical or mental disability, or sexual orientation.
  • Informed Consent

  • General Authorization and Release Pursuant to Minnesota Statutes §13.05, Subd. 4, Minnesota Data Practices Act

    I hereby authorize and grant my informed consent to permit the release of data to the police department serving the City of Madelia, Minnesota, and/or its agent and/or representatives, data classified as private which concerns me and that may be in your possession. The data which I authorize to be release consists of private data as define by Minnesota Statutes §13.04, Subd. 12, and has been collected by you as a result of my contacts and associations with you and/or your representatives. The information from which release is authorized includes all data which has been collected, created, received, retained, or disseminated in whatever form which in any way relates to my dealings with you or your agency. I understand that the following types of data are among those pertinent to the review of my employment applications: educational records, military record, employment data (current and former), arrest records, conviction records, professional and personal references, and driver’s license records. I understand that the purpose of permitting the City of Madelia to have access to this information is to determine my suitability for employment.

    I understand that any decision to hire me is contingent upon the results of an investigatory report. I further understand that misrepresentation or omission of information will be sufficient cause, in and of itself, for rejection or dismissal whenever discovered. I hereby release any person who provides information pursuant to this document from any claims or liability by me or on my behalf.

    By signing this authorization, I hereby release the Police Department serving the City of Madelia and the Bureau of Criminal Apprehension from any and all liability which otherwise may or does happen as a result of the release of any and all data, regardless of its accuracy. I also release the City of Madelia from any and all liability for its receipt and use of data received pursuant to their consent.

    This authorization or a copy of this authorization shall be valid for a period of one year, but I reserve the right to, at any time prior to the expiration, cancel the written authorization by providing written notice to the City or to you of that fact.

  • Date Format: MM slash DD slash YYYY
  • Applicant Information

  • Date Format: MM slash DD slash YYYY