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City of <br /> <br />iver <br /> <br /> APPLICATION <br />FOR EMPLOYMENT <br /> <br />P.O. Box 723 * 13065 Orono Parkway · Elk River, MN 55330 · Phone: (612) 441-2324 * Fax: (612) 441-8937 <br /> <br /> We consider applicants for all positions without regard to race, color, creed, religion, sex, national origin, age, <br />marital status, disability, or any other legally protected category which we are obligated to recognize. <br /> <br /> (PLEASE PRINT) <br /> <br />POSITION(S) APPLIED FOR DATE OF APPLICATION <br /> <br /> Assistant Chief of Poi~ce 1-14-97 <br /> <br />LAST NAME FIRST NAME MIDDLE NAME <br /> Beahen Je:~£]~ey <br /> <br />ADDRESS NUMBER STREET CITY STATE <br /> <br />ZIP <br /> <br />TELEPHONE NUMBER(S) I SOCIAL SECURITY NUMBER <br /> / <br />you are under 18 years of age, can you provide required proof of your eligibility to work? [] Yes <br /> <br />Have you ever filed an application with us before? <br /> <br />Have you ever been employed with us before? <br /> <br />Are you currently employed? <br /> <br />May we contact your present employer? <br /> <br /> [] No <br /> ~1 Yes [] No <br /> <br />If Yes, give date May 1980 <br /> <br /> I~ Yes [] No <br />If Yes, give date5-80 - 10-85 <br /> <br />Are you prevented from lawfully becoming employed in this country because of <br /> Visa or Immigration Status? <br /> (Proof of citizenship or immigration status will be required upon employment.) <br /> <br />On what date would you be available to work? <br /> <br />Are you available to work: r-X Full-Time [] Part-Time [] Shift Work <br /> <br />Are you currently on "lay-off". status and subject to recall? <br /> <br />Have you been convicted for a crime for which a jail sentence may be imposed? <br /> (Conviction will not necessarily disqualify an applicant frOm employment.) <br /> <br />If yes, please explain: <br /> <br />[] Temporary <br /> <br />Yes [] No <br /> <br />Yes [] No <br /> <br />[] Yes ~ No <br /> <br />Must give 2 week <br /> <br />[] Yes ~ No <br />[] Yes ~ NO <br /> <br />notice <br /> <br />WE ARE AN EQUAL OPPORTUNITY EMPLOYER <br /> <br /> <br />