School, Address	Did you Graduate?	Certificate/Diploma/Degree Earned	Major/Minor
High School	Yes No GED		N/A
College/University/Technical School	Yes No
College/University/Technical School	Yes No
College/University/Technical School	Yes No

Current/ Most Recent Employer	Dates of Employment: From To Total Years:    Total Months:
City State Zip Code MN ND AL AK AS AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MH MD MA MI MS MO MT NE NV NH NJ NM NY NC OH OK OR PA RH SC SD TN TX UT VT VA WA WV WI WY	Reason for Leaving:
Position Title:	Last Salary:
Supervisor's Name:	May we contact this person? Yes  No   N/A
Supervisor's Title:	Telephone:
Primary Responsibilities:

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Prior Employer	Dates of Employment: From To Total Years:    Total Months:
City State Zip Code MN ND AL AK AS AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MH MD MA MI MS MO MT NE NV NH NJ NM NY NC OH OK OR PA RH SC SD TN TX UT VT VA WA WV WI WY	Reason for Leaving:
Position Title:	Last Salary:
Supervisor's Name:	May we contact this person? Yes  No   N/A
Supervisor's Title:	Telephone:
Primary Responsibilities:

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Prior Employer	Dates of Employment: From To Total Years:    Total Months:
City State Zip Code MN ND AL AK AS AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MH MD MA MI MS MO MT NE NV NH NJ NM NY NC OH OK OR PA RH SC SD TN TX UT VT VA WA WV WI WY	Reason for Leaving:
Position Title:	Last Salary:
Supervisor's Name:	May we contact this person? Yes  No   N/A
Supervisor's Title:	Telephone:
Primary Responsibilities:

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  Describe any other past training or experience - paid or unpaid - that has prepared you for this job. Please be specific.

List all machines and equipment which you have experience operating.

Please briefly summarize all the reasons why you think you should be selected for this job.

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 in the City of Moorhead and in the administration of personnel 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.

I certify that I have read (or had read to me) the information printed above and understand its meaning.	DATE:

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.

My typed signature signifies agreement to the above.		Date

A. General Requirements: Applicants must meet all of the following to qualify for any preference points:
    1) Meets qualifications of position and/or received final passing score in the exam process without addition of preference points.
    2) Separated under honorable conditions from any branch of the armed forces of the United States.
    3) Served on active duty for 181 consecutive days or more or was separated by reason of disability incurred while serving on active duty.
    4) Is a United States citizen.
    5) Is not eligible for or currently receiving a monthly veteran’s pension benefit based on length of military service.

Veteran(10 points): Honorably discharged veteran (DD214 must be submitted to receive points)	YESNO
Disabled Veteran (15 points): (DD214 and USDVA letter of disability rating decision of 10% or more or an Armed Forces Retirement Board showing a service connected disability and a compensation amount must be submitted to receive points)	YESNO
Spouse of disabled Veteran (15 points): (DD214 and USDVA letter of disability rating decision of 10% or more, or an Armed Forces Retirement Board showing a service connected disability and a compensation amount must be submitted to receive points)	YESNO
Spouse of deceased Veteran (10 points): (DD214, photocopy of marriage certificate, spouse's death certificate and proof veteran died on or as a result of active duty must be submitted to receive points You are ineligible to receive points if you were remarried or were divorced from the veteran	YESNO
Spouse of deceased Veteran who had a service-connected disability (15 points): (DD214, photocopy of marriage certificate, spouse's death certificate and proof veteran died on or as a result of active duty must be submitted to receive points You are ineligible to receive points if you were remarried or were divorced from the veteran	YESNO
Affidavit: I hereby claim Veteran’s Preference for this examination and swear/affirm that the information given is true, complete and correct to the best of my knowledge. I hereby acknowledge that I am responsible to obtain the Veterans’ preference verification documents and submit them to the City of Moorhead by the required application deadline date.
My typed signature signifies agreement to the above	Date: