Fillable Printable Application for Employment - Wisconsin
Fillable Printable Application for Employment - Wisconsin
Application for Employment - Wisconsin
OSER-DMR S-38 (rev. 06- 10)
Wis. Stats. 230.16
STATE OF WISCONSIN
APPLICATION FOR STATE EMPLOYMENT
General Instructions
These instructions are for use in completing the Application for State Employment, form OSER-DMRS-38.
Applications will be accepted only
for vacancies announced online at www.Wisc.Jobs, WiscERS.state.wi.us (for at-risk or
laid-off state employees only), or in the Wisc.Jobs Bulletin.
Read the announcement carefully and submit application materials to the address listed in the announcement.
Print clearly! If we cann ot read your information we cannot process your application.
You must
provide the following : job announcement title, job announcement code, first name, last name, last four
digits of social security number, month of birth, day of birth, mother’s ma iden name (last name only), mailing
address, city, state, zip code, country, legal authorization to work in the U.S., Wisconsin residency, work hours,
county(ies) where you will accept employment, and signature on certification statement.
You must ensure that the completed, signed application is received on or before the announced deadline date, at the specified
location. The Office of State Employment Relations (OSER) and other state agencies are not responsible for late, lost,
misdirected or damaged mail.
You may take clean photocopies of the application, printed front an d back
on one sheet of paper, and submit that as the
official application.
As a veteran with an honorable discharge or a spouse of a veteran, you may be eligible to receive additional points on your
civil service scores. Current state employees are not eligible for veterans points. Please view the Veterans Preference
Supplement form OSER-MRS-38L, found online at http://OSER.state.wi.us
under “Jobs” at Application Forms.
Qualified persons with a disability may be eligible for consideration in the interv iew pro cess. Please complete th e Disabled
Expanded Certification form OSER-MRS-159, found online at http://OSER.state.wi.us
under “Jobs,” at Application Forms.
Questions should be directed to the contact in the job announcement, or the Office of State Employment Relations,
Employment Services Center can be contacted by telephone (608) 266-1731, or e-mail [email protected]
.
SCORE REUSE
: Some exams allow applicants to reuse their score instead of retaking the ex am, and the grade notice will
indicate if an applicant can use this option. Applicants interested in sco re reus e should do so by th e Score Reuse date
indicated on their Notice of Examination Results or Reuse Score By date in their online Wisc.Jobs job cart. This can be
completed online by creating an account on www.Wisc.Jobs
or checking the score reuse box in section 1 of this application
(under the job announcement title) and submittin g to the contact on your grade notice or the Office of State Employment
Relations, P.O. Box 7855, Madison, WI 53707-7855. Applicants also may call the Office of State Employment Relations,
Employment Serv ices Center at (608) 266-1731, or e-mail ESC@wisconsin.gov
. Refer to www.Wisc.Jobs or the contact
listed in the job announcement for more information.
State of Wisconsin
Application for State Employment - Instructions - page 2 of 4
OSER-DMR S-38 (rev. 06- 10)
Wis. Stats. 230.16
1. JOB ANNOUNCEMENT TITLE
A job title is required to process your application. Complete an application for each job you apply for unless the job titles
were announced in the same announcement. Enter the job title as it appears in the announcement.
JOB ANNOUNCEMENT CODE
An accurate Job Announcement Code is required to process your application. The Job Announcement Code is listed in the
heading of the job announcement. If the job announcement lists two Job Announcement Codes, enter the second code on the
line provided.
2. NAME
A last name, first name, and middle initial (if applicable) are required to process you r application .
LAST FOUR DIGITS OF SOCIAL SECU RITY NUMBER
The last four digits of your Social Security Number ar e required to process your application.
DATE OF BIRTH
Use numbers to identify the month and day you were born (MM and DD) example: January 2 would be 01 and 02. The
month and day of your birth are required to process your application. Year of birth is optional and is used as an additional
identifier only.
MAILIN G A D DRESS
Your Address, City, State, Zip Code and Coun try are required to process your application. If you have an existing Wisc.Jobs
job cart you may update your infor mation online anyti me at www.Wisc.Jobs
. If you do not have an existing j ob cart, you
may create one at www.Wisc.Jobs or notify the Office of State Employment Relations by mail: P.O. Box 7855, Madison, WI
53707-7855; phone (608 ) 266-1731; or e-mail [email protected].
MOTHER'S MAIDEN NAME
This information is required to process you r application. Enter your mother’s maiden name (last name only) or another name
or word that will serve as an additiona l identifier to make your applicant record uniqu e.
PHONE NUMBER(S)
Please provide a phone number(s) where you can be reache d if there are questions regarding your application or to schedule
an interview.
3. LEGALLY AUTHORIZED TO WORK IN THE U.S.
Completion of this section is required to process your application . Check YES only if you are one of the following: (1) a
citizen or national of the United States; (2) a lawful permanent resident; or (3) an alien authorized to work in the United
States.
4. WISCONSIN RESIDENCY
Completion of this section is required to process your application. Indicate whether you are a permanent resident of the State
of Wisconsin. Wisconsin residency is required only for Limited Term and Project positions.
5. WORK HOURS
You must include the type of work you will accept in order for us to process your application. Check all types of w or k hou rs
that you will accept.
INSTRUCTIONS CONTINUE ON THE NEXT PAGE
State of Wisconsin
Application for State Employment - Instructions - page 3 of 4
OSER-DMR S-38 (rev. 06- 10)
Wis. Stats. 230.16
6. COUNTIES WHERE YOU WILL ACCEPT EMPLOYMENT (PLEASE NOTE THAT COUNTY CODES HAVE CHANGED.)
At least one code is required to process your application. Select the desired code(s) below for the county(ies) where you will
accept work and transfer that two-digit number to section 6 in the application. We will only consider you for jobs in the
locations you indicate on your application.
Code
County Code County Code County Code County Code County
00 - All Counties 15 - Door 30 - Kenosha 44 - Outagamie 59 - Sheboygan
01 - Adams 16 - Douglas 31 - Kewaunee 45 - Ozaukee 60 - Taylor
02 - Ashland 17 - Dunn 32 - La Crosse 46 - Pepin 61 - Trempealeau
03 - Barron 18 - Eau Claire 33 - Lafayette 47 - Pierce 62 - Vernon
04 - Bayfield 19 - Florence 34 - Langlade 48 - Polk 63 - Vilas
05 - Brown 20 - Fond du Lac 35 - Lincoln 49 - Por tage 64 - Walwo rth
06 - Buffalo 21 - Forest 36 - Manitowoc 50 - Price 65 - Wash burn
07 - Burnett 22 - Grant 37 - Marathon 51 - Racine 66 - Wash ington
08 - Calumet 23 - Green 38 - Marinette 52 - Richland 67 - Waukesha
09 - Chippewa 24 - Green Lake 39 - Marquette 53 - Rock 68 - Waupaca
10 - Clark 25 - Iowa 72 - Menominee 54 - Rusk 69 - Waushara
11 - Columbia 26 - Iron 40 - Milwaukee 55 - St. Croix 70 - Winnebago
12 - Crawfor d 27 - Jackson 41 - Monroe 56 - Sauk 71 - Wood
13 - Dane 28 - Jefferson 42 - Oconto 57 - Sawyer 99 - Outside Wisconsin
14 - Dodge 29 - Juneau 43 - Oneida 58 - Shawano
Cities with popu lation of
more than 100,000:
Madison (state capital) is
in Dane County, code 13
Milwaukee (larg e st city)
is in Milwaukee County,
code 40
Green Bay is in Brown
County, code 05
State of Wisconsin
Application for State Employment - Instructions - page 4 of 4
OSER-DMR S-38 (rev. 06- 10)
Wis. Stats. 230.16
7. GENDER - Check only one box.
8. RACE/ETHNICITY - Check only one box using the following definitions:
Black--Not of Hispanic origin: All persons having origins in any of the b lack racial groups of Africa.
Asian or Pacific I s lander: All persons having origin s in any of the original peoples of the Far East, Southeast Asia, the
Indian Sub continent, or the Pacific Islands.
American Indian or Alaska Native
: Persons descending from any of the original peoples of North America who possess ¼
degree of docu m e nt ed tribal d escen dancy or are enrolled with a federally or state recognized tribe, or are recognized by a
federally or state recognized tribe as American Indians for state affirmative action purposes.
Hispanic
: All persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin,
regardless of race.
White--Not of Hispanic origin
: All persons having origins in any of the original p eoples of Europe, North Africa, or the
Middle East.
Gender and race/ethnicity information is used for equal employment opportunity/affirmative action (EEO/AA) purposes only. This information
is confidential and is retained by state human resources professionals. If you do provide this information, you may be eligible for further
consideration of job opportunities through the State of Wisconsin EEO/AA Plan.
9. EDUCATION LEVEL
- Check only one box on the application . Ind icate your single highest level of educatio n completed.
10. HOW DI D YO U FI ND OUT AB O UT THI S J OB?
Please identify the source(s) of information that led you to apply for this vacancy. Use the check boxes on page 2 of the
application.
11. ACTIVE M ILIT ARY DUTY
If you are an active military duty member and unable to test at the regularly scheduled exa m centers, complete this section
along with the rest of the required application information, and return to the Office of State Employment Relations; Attention
Exam Administr a tion Coordinator; P.O. Box 7855; Madison, WI 53707-7855.
12. CERTIFICATION STATEMENT
Your application must be signed in order to process the application.
Thank you for your interest in Wisconsin State Government employment. Wisconsin wants to find the best qualified people
available to serve its citizens. Although everyone who applies cannot be hired, your applicatio n will be given every consid eration.
Search State of Wisconsin government employment opportunities online
at www.Wisc.Jobs
.
OSER-DMRS-38 (rev. 06-10)
Wis. Stats. 230.16 1 of 2
STATE OF WISCONSIN
APPLICATION FOR STATE EMPLOYMENT
1. * Job Information
Job Announcement Title (Complete an application for each job.) Job Announcement Code(s) (seven digits)
____ ____ - ____ ____ __ __ ____ ____
____ ____ - ____ ____ __ __ ____ ____
Score Reuse: Some exams allow applicants to reuse their exam scores. See page 1 of t he instructions to learn more about score reuse.
2. Personal Information
* Last Name: * First Name: Middle Initial:
* Last Four Digits of Social Security Number:
____ ____ ____ ____
*Month of Birth (MM):
____ ____
*Day of Birth (DD):
____ ____
Year of Birth (YYYY)
(optional) __ __ __ __
* Mailing Address 1:
Mailing Address 2: *Mother’s Maiden Name: (last name only)
* City: * State: * Zip Code: * Country:
E-Mail Address:
Daytime Phone Number: Evening Phone Number:
Other Phone Number (e.g., cell): Fax Number:
3. * Are you currently legally authorized to work in the United States? Yes No
4. * Are you a Wiscon sin resident? Yes No
5. * Work Hours (Check all that you will accept.)
Full Time (40 hrs/week)
Part Time
(less than 40 hrs/w eek)
Seasonal
(minimum of 600 ho urs per year but less
than 1,828 hours per year.)
Evening 2
nd
Shift (3pm to 11 pm or similar hours)
Evening 3
rd
Shift (11pm to 7am or similar hours)
6. * Counties Where You Will Accept Employment (PLEASE NOTE THAT COUNTY CODES HAVE CHANGED.)
County Code(s): __ __ | __ __ | __ __ | __ __ | __ __ | __ __ | __ __ | __ __ | __ __ | __ __ | __ __
Administrative Use Only
* Indicates mandator
y
fields
Application continues on next page
Note: We will only consider you for jobs in the locations you indicate below. You must identify at least one county for us to
process your applicatio n. Enter 2-digit County Code(s) below using the list provided on page 3 of the instructions.
OSER-DMRS-38 (rev. 06-10)
Wis. Stats. 230.16 2 of 2
Gender and race information are used for equal employmen t opportunity/affirmative action purposes only.
7. Gender 8. Race / Ethnicity
Female Male
9. Education Level
10. How did you hear about this job?
1. Office of State Employment Relations Internet:
2. Job Service/Job Center 9. Wisc.Jobs
3. State Agency/UW Cam pus 10. JobCenterOfWisconsin.com (JobNet)
4. Wisc.Jobs Bulletin 11. State Agency/UW Campus Website
5. Referred by Current State Employee
6. Referred by Friend or F amily
7. Job Fair 12. Other:______________ ______________
8. Newspaper Please list other source
11. Active Duty Military
12. * Certification Statement
By signing below, I certify that the information I have provided in this application is true to the best of my knowledge and
I understand that I may be required to verify the information before being appointed. I understand that any false,
misleading, or missing information may disqualify me from employment consideration.
* Signature:_________________________________ ______________________ ____ Date: __ __ / __ __ / __ __ __ __
(Check only one.)
1. Black (not Hispanic)
2. Asian or Pacific
Islander
3. American Indian or Alaskan
Native
4.
Hispanic
5. White (not Hispanic)
(Check highest level completed.)
1. Did not co mplete high school/GED
2. Completed GED/HSED
3. Graduated from high school
4. Some college, no degree
5. One-ye ar vocational diploma
6.
Two-year asso ciate degree
7. Bachelor's degre e
8. Some graduate degree courses
9. Grad uate college degre e
We will test active duty military members stationed out of state who are unable to test at a regularly scheduled exam center. We
will test only at approved U.S. military installations and only if the exam is administered by a Test Control Officer or equivalent
person. Please provide the following information for the person who has agreed to administer the exam. A fee may be charged
for this service.
Test Control Officer: Last Name:_______________________________ First Name:__________________________ M.I.:____
Title:___________ ________________________ _______ __ Agency:_____________ _______ ________________________ ___
Complete Mailing Addr ess:________________________ _______ ________________________ _______ ____________ ________
City:___ ________ ____________________ State:______ _ Zip:_______________ ___ Phone:__________________ ________
