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General Information

Which position are you applying for?*
Date Available for Work*
Date Available for Work
Last Name*
First Name*
Middle Name*
Street Address*
City*
State*
Zip*
Email Address*
Personal Phone*
Business Phone
Employment Position Desired*
Check any you would accept.
1. Permanent
1. Temporary
1. Full-Time
1. Part-Time
Have you previously been employed by the City?*
1. Yes
1. No
If yes, what position?
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Work Experience

Education

Job Relevant Volunteer & Unpaid Work Experience

Kind of Volunteer Activity
Do not specify organization.
Hours Per Month
Years Involved
Years Involved Start Date
—
Years Involved End Date
Major Responsibilities
Percent of Time Per Responsibility
Add Additional Volunteer & Unpaid Work Experience?
1. Yes
2. No
Kind of Volunteer Activity
Do not specify organization.
Hours Per Month
Years Involved
Years Involved Start Date
—
Years Involved End Date
Major Responsibilities
Percent of Time Per Responsibility
Add Additional Volunteer & Unpaid Work Experience?
1. Yes
2. No
Kind of Volunteer Activity
Do not specify organization.
Hours Per Month
Years Involved
Years Involved Start Date
—
Years Involved End Date
Major Responsibilities
Percent of Time Per Responsibility
Describe any additional experience or training that qualifies you for this job.
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Office Equipment, Word Processing & Computer Experience

Hardware Experience
Be specific.
Software Experience
Be specific.
Other
Typing Speed
Words Per Minute
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References

Give the names of at least four people other than relatives who can be contacted regarding your qualifications, work habits, and character.
Full Name*
Present Address*
Position and Relation to Your Work*
Phone Number*
Full Name*
Present Address*
Position and Relation to Your Work*
Phone Number*
Full Name*
Present Address*
Position and Relation to Your Work*
Phone Number*
Full Name*
Present Address*
Positions and Relation to Your Work*
Phone Number*
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Legal to Work

Do you legally have the right to work in the United States?*
1. Yes
1. No
In accordance with the Immigration Reform and Control Act of 1986, the City of St. Anthony hires only U.S. Citizens and lawfully authorized alien workers. If hired, you will be required to provide written documentation of citizenship or Legalized Alien Program.
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Criminal Record

BACKGROUND CHECKS
THE CITY OF ST. ANTHONY CONDUCTS CRIMINAL HISTORY BACKGROUND CHECKS ON ALL EMPLOYEES.

FOR SWORN POLICE POSITIONS, FELONY CONVICTIONS (AND CERTAIN OTHER CONVICTIONS MANDATED BY THE STATE LICENSING BOARD FOR POLICE) WILL AUTOMATICALLY DISQUALIFY YOU FROM FURTHER CONSIDERATION. FOR NON-POLICE POSITIONS, THE CITY WILL LOOK AT THE TYPE OF CONVICTION AND WHETHER IT IS DIRECTLY RELATED TO THE JOB FOR WHICH YOU ARE APPLYING.

CANDIDATES FOR POSITIONS WORKING WITH CHILDREN WILL NOT BE SELECTED IF THEY HAVE BEEN CONVICTED OF ANY CRIME LISTED IN THE CHILD PROTECTION WORKER ACT (MINNESOTA STATUTES 299C.61 & 62). GENERALLY THIS INCLUDES CHILD ABUSE CRIMES, MURDER, MANSLAUGHTER, FELONY LEVEL ASSAULT OR ANY CRIME COMMITTED AGAINST A MINOR, KIDNAPPING, ARSON, CRIMINAL SEXUAL CONDUCT, AND PROSTITUTION RELATED CRIMES.

BEFORE ANY APPLICANT (OTHER THAN APPLICANTS FOR POSITIONS WITHIN THE POLICE OR FIRE DEPARTMENT) IS REJECTED ON THE BASIS OF CRIMINAL CONVICTION, HE OR SHE WILL BE NOTIFIED IN WRITING AND WILL BE GIVEN ANY RIGHTS AFFORDED BY MINNESOTA STATUTES CHAPTER 364. THIS INCLUDES THE RIGHT TO SHOW EVIDENCE OF REHABILITATION.
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Accommodations

Do you have any physical or health limitations that would require special or reasonable accommodations by the City?*
1. Yes
2. No
If yes, please describe the nature of the accommodation.
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Tennessen Warning/Data Practices Notice to All Applicants

TENNESSEN WARNING/DATA PRACTICES NOTICE TO ALL APPLICANTS
THE MINNESOTA GOVERNMENT DATA PRACTICES ACT REQUIRES THAT YOU BE INFORMED OF THE PURPOSES AND INTENDED USES OF THE INFORMATION YOU PROVIDED TO THE CITY OF ST ANTHONY DURING THE APPLICATION PROCESS OR DURING EMPLOYMENT. ANY INFORMATION ABOUT YOURSELF THAT YOU PROVIDE WILL BE USED TO IDENTIFY YOU AS AN APPLICANT AND TO ASSESS YOUR QUALIFICATIONS FOR EMPLOYMENT WITH THE CITY. IF YOU WISH TO BE CONSIDERED FOR EMPLOYMENT, YOU ARE REQUIRED TO PROVIDE THE INFORMATION REQUESTED IN THE APPLICATION FOR EMPLOYMENT. IF YOU REFUSE TO SUPPLY INFORMATION REQUESTED BY THE CITY, IT MAY MEAN YOUR APPLICATION WILL NOT BE CONSIDERED.

YOU ARE HEREBY ADVISED THAT, UNDER MINNESOTA LAW, THE FOLLOWING INFORMATION GIVEN BY AN APPLICANT IS CONSIDERED TO BE PUBLIC: VETERAN STATUS, RELEVANT TEST SCORES, RANK ON OUR ELIGIBLE LIST; JOB HISTORY; EDUCATION AND TRAINING; WORK AVAILABILITY.

AS AN APPLICANT, YOUR NAME IS CONSIDERED PRIVATE UNTIL YOU ARE CERTIFIED AS ELIGIBLE FOR APPOINTMENT TO A POSITION OR WHEN APPLICANTS ARE CONSIDERED BY THE APPOINTING AUTHORITY TO BE FINALISTS FOR A POSITION WITH THE CITY OF ST ANTHONY. “FINALIST” MEANS AN INDIVIDUAL WHO IS SELECTED TO BE INTERVIEWED BY THE APPOINTING AUTHORITY PRIOR TO SELECTION.

THE DATA CONCERNING YOU, WHICH IS PLACED IN YOUR APPLICATION FOLDER OR IN YOUR PERSONNEL FILE AND WHICH IS NOT LISTED AS PUBLIC, IS PRIVATE. THIS PRIVATE DATA WILL BE SHARED WITH YOU AND THOSE MEMBERS OF THE CITY STAFF WHO NEED IT TO PROCESS THE APPLICATION, UPDATE YOUR PERSONNEL RECORD, EVALUATE YOUR WORK PERFORMANCE AND IF YOU ARE HANDICAPPED, PROVIDE THE NECESSARY ACCOMMODATIONS. IT MAY ALSO BE SHARED WITH THE FOLLOWING: PERSONS AUTHORIZED TO HAVE ACCESS TO THE INFORMATION UNDER STATE OR FEDERAL LAW; PERSONS AUTHORIZED BY COURT ORDER TO HAVE ACCESS TO THE INFORMATION; AND PERSONS TO WHOM YOU CONSENT IN WRITING TO HAVE ACCESS TO THE INFORMATION.

WITH THE EXCEPTION OF RACIAL AND ETHNIC DATA, THE DATA YOU GIVE US ABOUT YOURSELF IS NEEDED TO IDENTIFY YOU AND TO ASSIST DETERMINING YOUR SUITABILITY FOR THE POSITION FOR WHICH YOU ARE APPLYING. RACIAL AND ETHNIC DATA IS USED TO MONITOR PROTECTED CLASS EMPLOYMENT AND TO MEET FEDERAL, STATE, AND LOCAL REPORTING REQUIREMENTS. FURNISHING RACIAL AND ETHNIC DATA ABOUT YOURSELF, AS WELL AS YOUR SOCIAL SECURITY NUMBER, IS VOLUNTARY.

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION FOR EMPLOYMENT AS MAY BE NECESSARY IN ARRIVING AT AN EMPLOYMENT DECISION. I UNDERSTAND THAT THIS APPLICATION IS NOT, AND IS NOT INTENDED, TO BE A CONTRACT FOR EMPLOYMENT. IN THE EVENT OF EMPLOYMENT, I UNDERSTAND THAT FALSE OR MISLEADING INFORMATION GIVEN IN MY APPLICATION, OR INTERVIEW(S), MAY RESULT IN DISCHARGE. I UNDERSTAND ALSO, THAT I AM REQUIRED TO ABIDE BY ALL RULES AND REGULATIONS OF THE CITY.

I CERTIFY THAT ANSWERS HEREIN ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I CERTIFY THAT I HAVE READ THE “NOTICE TO APPLICATION” REGARDING THE MINNESOTA DATA PRACTICES ACT (MN STATUTES 1301-1390), AND I UNDERSTAND MY RIGHTS AS A SUBJECT OF DATE.
CONSENT
AS AN APPLICANT FOR A POSITION WITH THE CITY OF ST. ANTHONY VILLAGE, I CONSENT TO THE CITY OF ST. ANTHONY VILLAGE POLICE DEPARTMENT CONDUCTING A CRIMINAL HISTORY BACKGROUND INVESTIGATION ON ME. I UNDERSTAND THAT THE INFORMATION I PROVIDE IS CLASSIFIED AS PRIVATE. I CONSENT TO THE RELEASE OF THE INFORMATION I AM PROVIDING IN THIS BACKGROUND INVESTIGATION FORM AND ANY OTHER INFORMATION OBTAINED AS A RESULT OF THIS BACKGROUND INVESTIGATION, AS IS NECESSARY AND APPROPRIATE, TO THE CITY OF ST. ANTHONY VILLAGE.

Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.
Applicant Signature*
Date*
Date
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Disclaimer & Signature

DISCLAIMER*
I UNDERSTAND THE CITY OF ST. ANTHONY HAS THE RIGHT TO VERIFY INFORMATION PROVIDED IN THE APPLICATION. IF THERE ARE ANY MISREPRESENTATIONS ON THIS APPLICATION OR MY RESUME OR MADE BY ME IN AN INTERVIEW, WHICH MAY BE DISCOVERED NOW OR ANY TIME IN THE FUTURE, I MAY BE DISCHARGED FOR CAUSE WITHOUT SEVERANCE PAY OF ANY KIND. FALSE INFORMATION OR MISREPRESENTATION MAY ALSO SUBJECT ME TO THE PENALTY PROVISIONS OF M.S. § 43A.39.

IN CONNECTION WITH THIS APPLICATION FOR EMPLOYMENT, I AUTHORIZE THE CITY OF ST. ANTHONY AND ANY AGENT ACTING ON ITS BEHALF TO CONDUCT ANY INQUIRY INTO ANY JOB-RELATED INFORMATION CONTAINED IN THIS APPLICATION, INCLUDING, BUT NOT LIMITED TO, MY RECORDS MAINTAINED BY AN EDUCATIONAL INSTITUTION RELATING TO ACADEMIC PERFORMANCE (such as transcripts). MOREOVER, I HEREBY RELEASE THE CITY OF ST. ANTHONY AN ANY AGENT ACTING ON ITS BEHALF FROM ANY AND ALL LIABILITY BT REASON OF REQUESTING SUCH INFORMATION FROM ANY PERSON.
1. Yes.
2. Yes, but not present employer until job is offered.
3. No (We may be unable to hire you without this information).
Signature
I DECLARE THAT ANY AND ALL STAEMENTS IN THIS APPLICATION OR INFORMATION PROVIDED ARE TRUE AND COMPLETE AND HEREBY ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE INFORMATION CONTAINED HEREIN.
Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature*
Date*
Date
THE CITY OF ST. ANTHONY IS AN AFFIRMATIVE ACTION EQUAL OPPORTUNITY EMPLOYER.
THE CITY OF ST. ANTHONY DOES NOT DISCRIMINATE ON THE BASIS OF RACE, COLOR, NATIONAL ORIGIN, SEX, RELIGION, AGE, SEXUAL ORIENTATION, FAMILIAL STATUS OR DISABILITY IN EMPLOYMENT OR THE PROVISION OF SERVICES.

THE CITY OF ST. ANTHONY DOES NOT DISCRIMINATE ON THE BASIS OF HANDICAPPED STATUS IN THE ADMISSION OR ACCESS TO OR TREATMENT OF OR EMPLOYMENT IN, ITS PROGRAMS OR ACTIVITIES. IT IS THE POLICY OF THE CITY OF ST. ANTHONY TO PROVIDE REASONABLE ACCOMMODATIONS TO KNOWN PHYSICAL AND MENTAL LIMITATIONS OF QUALIFIED HANDICAPPED APPLICANTS AND EMPLOYEES IN ORDER FOR TO PERFORM THE ESSENTIAL FUNCTIONS OF THE JOB IN QUESTION.
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Veterans' Preference Points Settlement

Do you wish to apply for Veterans' Preference Points?*
1. Yes
1. No
If no, you may move on to the next page of this application. If yes, please complete the section below.
Information Regarding Claiming Veterans' Preference
Veterans' Preference Information (PDF)
Please review this information before completing your application.
COMPLETE THIS FORM ONLY IF YOU ARE CLAIMING VETERANS’ PREFERENCE
NOTE: COPY OF “MEMBER COPY 4” VETERAN’S DD214, OR OTHER DOCUMENTATION VERIFYING SERVICE, MUST BE ATTACHED

(Veteran is defined by Minnesota State § 197.447)
Upload Documents
Upload your "Member Copy 4" Veteran's DD214 or other documentation verifying service.
Application Process
You must submit a PHOTOCOPY of your “Member Copy 4” of your DD214 or other documentation verifying service to substantiate the services information requested on the form. Claims not accompanied by proper documentation will not be processed. For assistance in obtaining a copy of your “member Copy 4” of your DD214, or other documentation verifying service, contact your County Veterans’ Service Office.

The City of St. Anthony operates under a point preference system, which awards points to qualified veterans to supplement their application. Ten (10) points are granted to non-disabled veterans on open competitive examinations; Fifteen (15) points are awarded if the veteran has a service connected compensable disability as certified by the U.S. Department of Veterans Affairs (USDVA).

To qualify for preference for a competitive exam, you must have earned a passing score and been separated under honorable conditions from any 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, or after having served the full period called or ordered for federal, active duty and be a United States citizen or resident alien. Veteran’s preference may be used by the surviving spouse of a deceased veteran, or have active military service certified under 38 U.S.C. § 106, and by the spouse of a disabled veteran who is unable to qualify because of the disability.

To qualify for preference on a promotional exam, a veteran must have earned a passing exam score and received a USDVA active duty service connected disability rating of 50% or more. For a promotional exam, a qualified disabled veteran is entitled to be granted five (5) points. Disabled veterans eligible for such preference may use the five points preference only for the first promotion after securing employment with the City of St. Anthony.

Claims must be made on the form below and submitted with your application by the application deadline of the position for which you are applying. If the “Member Copy 4” DD214, or other documentation verifying service, is submitted to our office separate from this sheet, please attach a note with it indicating the position for which you are applying and your present address.
Last Name
First Name
Middle Initial
Position For Which You Applied
Full Address
(Street, City, State, Zip)
Phone Number
Are you a U.S. Citizen or Residential Alien?
1. Yes
1. No
Are you an honorably discharged veteran?
1. Yes
1. No
Veteran (10 Points): “Member Copy 4” of DD214 or DD215, or other documentation verifying service, must be submitted to receive points.
Percent of Disability
Disabled Veteran (15 Points): “Member Copy 4” of DD214, or other documentation verifying service, and USDVA letter of a compensable disability rating decision must be submitted to receive points.
Date of Death
Date of Death
Spouse of Deceased Veteran (10 Points or 15 if the Veteran was disabled at time of death): “Member Copy 4” of DD214 or DD215, or other documentation verifying service, and USDVA letter of a compensable service connected disability rating decision must be submitted to receive points.
Have you remarried?
1. Yes
1. No
How does Veteran's disability prevent performance of a stated job "requirement"? Due to the Veteran's service-connected disability, the Veteran is unable to qualify for this position because:
Spouse of Disabled Veteran (15 Points): "Member Copy 4” of DD214 or DD215, or other documentation verifying service, and USDVA letter of a compensable service connected disability rating decision must be submitted to receive points.
Affidavit
I hereby claim Veterans’ Preference points 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 required Veterans’ Preference verification documents and submit them to the City of St. Anthony by the required application deadline.
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature
Date
Date
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General Information

Work Experience

Education

Job Relevant Volunteer & Unpaid Work Experience

Office Equipment, Word Processing & Computer Experience

References

Legal to Work

Criminal Record

Accommodations

Tennessen Warning/Data Practices Notice to All Applicants

Disclaimer & Signature

Veterans' Preference Points Settlement

Voluntary Affirmative Action Information

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