Fillable Printable State of Minnesota Employment Application
Fillable Printable State of Minnesota Employment Application
State of Minnesota Employment Application
658 Cedar Street, St. Paul, MN 55155
Attn: HR Management
State of Minnesota
Employment Application
Must Attach Resume
To Be Considered
Job Information Line 651.259.3637
E-mail: careers@state.mn.us
Web Site: www.mn.gov/careers
Page 1
YOUR RIGHTS AS A SUBJECT OF DATA
Minnesota Statutes Chapter 13 requires that you be informed of the following about private data requested on this application.
Name, Home Address and Telephone Number are used to contact you about potential job opportunities. If this data is not provided, we may not be
able to contact you. If you are a finalist for a vacancy, your name becomes public data and is available to anyone.
Social Security Number is used to ensure accurate identification of your application, as distinguished from others' applications. If this data is not
provided, other data provided by you will be used for identification purposes.
Gender, Racial/Ethnic Group, and Disability status are used to comply with equal employment opportunity and affirmative action requirements as set
forth by law and to evaluate our efforts in ensuring diversity in the recruitment and selection of employees. If this data is not provided, it will be more
difficult for us to evaluate our efforts.
Reasonable Accommodation Information is used to provide reasonable accommodations in the hiring process. The data related to the request for a
reasonable accommodation will be maintained separately and treated as private medical records. If sufficient data is not provided, we may not be able to
accommodate you.
You are not legally required to provide any of the private data listed above. Employees from MMB and state agencies where your application is referred
may have access to your private data only if their work assignments reasonably require access during the hiring process. Others who may legally access
the above data are representatives of the Attorney General and Legislative Auditor, law enforcement agencies with statutory authority, and persons/entities
authorized by law or court order.
CONTACT INFORMATION
Name:
First MI Last
Address: Social Security No:
Email:
Phone: Home: ( )
City State Zip
Work:
(
)
SPECIFIC OPENING
If there is a specific opening for which you wish to be considered, please indicate the job posting number:
JOB LOCATIONS
Check each location where you will accept work. If you will accept a job in all of the cities listed under an area, check that area. Keep in mind that your name may be
removed from consideration for refusing a job at any location where you indicated you would work. You will be considered for positions only at the locations you indicate.
Twin Cities Area
Minneapolis
St. Paul
Twin Cities Suburbs - No. Area
Arden Hills, Brooklyn Park, Coon
Rapids, Fridley, Lino Lakes, New
Brighton, Roseville
Twin Cities Suburbs - So. Area
Apple Valley, Bloomington, Burnsville,
Eagan, Inver Grove Heights,
Rosemount
Twin Cities Suburbs - E. Area
Oakdale, White Bear Lake
Twin Cities Suburbs - W. Area
Golden Valley, Hopkins, Minnetonka,
Plymouth, St. Louis Park, Wayzata
Anoka
Hastings
Oak Park Heights
Shakopee
Stillwater
Northeast Area
Duluth
Ely
Eveleth
Grand Rapids
Hibbing
International Falls
Moose Lake
Togo
Virginia
Willow River
Silver Bay
Northwest Area
Bemidji
Brainerd
Crookston
Detroit Lakes
East Grand Forks
Fergus Falls
Itasca State Park
Moorhead
Staples
Thief River Falls
Wadena
Walker
Central Area
Alexandria
Cambridge
Little Falls
Mora
Morris
Pine City
Rush City
St. Cloud
Sauk Centre
Southeast Area
Albert Lea
Austin
Faribault
Mankato
Owatonna
Red Wing
Rochester
St. Peter
Winona
Southwest Area
Canby
Fairmont
Granite Falls
Hutchinson
Jackson
Luverne
Marshall
Montevideo
New Ulm
Pipestone
Willmar
Windom
Worthington
JOB GROUPINGS
Check the job groupings for which you’d like to be considered (up to 5 groupings).
Information Technology Health Care & Human Services
Administrative Support & Hospitality Construction, Facilities Maintenance, Manufacturing, & Transportation
General Administration, including Public Relations, Planning, & Engineering and Architecture
Executive Management Corrections, Public Safety & Legal
Finance, Regulatory, & Economic Development Human Resources
Environmental Sciences Education & Libraries
Page 2
EMPLOYMENT CONDITIONS
Check all you are willing to work.
All conditions Temporary, full-time
Shift:
All shifts TRAVEL: If you are willing to
Intermittent (on call as needed) Temporary, part-time Day shift travel in this job, check this box.
Permanent, full-time Seasonal, full-time Evening shift
Permanent, part-time Seasonal, part-time Night shift
Rotating shift
SALARY
Minimum Annual Salary you are willing to accept. $ /yr. I am interested in service or labor-type positions that do not
require prior work experience.
FOR CURRENT STATE EMPLOYEES ONLY
Name of Department (not division) where you work AND current job classification.
Are you interested in transfers within your same class at a different agency? Yes No
Are you interested in demotions to job classes included in resume-based selection? Yes No
EQUAL EMPLOYMENT OPPORTUNITY INFORMATION
Please check the appropriate boxes:
Gender:
Male
Female
With which racial/ethnic group do you identify?
Asian or Pacific Islander American Indian or Alaskan
Native
African American (Black) Caucasian (White)
Hispanic Other
Disability status: An individual with a disability is a person who (1) has a physical,
sensory, or mental impairment which substantially limits one or more major life
activities; (2) has a record of such an impairment; or (3) is regarded as having such an
impairment.
Do you claim disability status?
Yes
No
If you need a reasonable accommodation, please specify type of accommodation
needed.
VETERANS
PREFERENCE
You will be required to
provide proof of the
Veterans Preference you
claim before you are
hired.
To qualify for Veterans Preference, you must meet all of the following.
1) Have separated under honorable conditions from any branch of the armed forces of the United States.
2) Have served on active duty for 181 consecutive days or more OR for the full period ordered to active duty OR have separated by reason
of disability incurred while serving on active duty.
3) Be a United States citizen OR resident alien.
If you or your spouse meet all the above, check the appropriate box(es) below.
I am a non-disabled veteran.
I am a disabled veteran with a currently existing, compensable, service-connected disability as judged by the U.S. Veteran's
Administration or by the Retirement Board of the Branches of the Armed Forces.
I am the widow/widower (not remarried) of a deceased veteran.
I am the spouse of a disabled veteran who is unable to qualify because of the disability.
RECENTLY
SEPARATED
VETERAN
To qualify as a recently separated veteran, you must:
1.
meet all the requirements for Veterans Preference above and
2. have served in active military service at any time on or after September 11, 2001 as shown on your DD-214.
Note: If invited to interview, you will be required to present your DD-214 to verify that you meet the recently separated veteran requirement.
I am a recently separated veteran.
WHERE
DID YOU HEAR
ABOUT THIS
JOB?
The following information will help us evaluate our recruiting program. Please check the appropriate box.
State of Minnesota Employment Web Site
State Agency or Agency Web Site
Other Web Site
Minnesota Workforce Center
Job Information Line
Referred by State Employee
I am a State Employee
Newspaper
College/University/Technical School Posting
Other
- IMPORTANT -
The State has the right to verify information provided in this application and resume and any supplemental information through use of the informed consent provisions of
Minnesota Chapter 13. False information may subject an applicant to the penalty provisions of M.S. 43A.39. I understand that the State of Minnesota and any agent acting on
its behalf may conduct an inquiry into any job-related information contained in this application, resume and any supplemental information including, but not limited to, my
records maintained by an educational institution related to academic performance such as transcripts and information on any relevant criminal convictions. I hereby release
the State of Minnesota and any agent acting on its behalf from any and all liability of whatsoever nature by reason of requesting such information from any person or entity.
I understand that, on the date of hire, I will be required to provide proof of eligibility to work in the United States.
I declare that all information in this application, resume and any supplemental information is true and complete and hereby acknowledge that I have read and understood the
information above.
Date Signature (do not print)
MUST ATTACH RESUME TO THIS APPLICATION TO BE CONSIDERED.
If you need this information in alternative formats, call 651.259.3637 or email careers@state.mn.us.
THE STATE OF MINNESOTA IS AN EQUAL OPPORTUNITY, AFFIRMATIVE ACTION EMPLOYER
