P. O. Box 81, New Prague, MN 56071 Phone: 952.758.4334 Fax: 952.758-4336 www.map-inc.org

MAP IS AN EQUAL OPPORTUNITY EMPLOYER
MAP is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal laws. Applicants requiring reasonable accommodation in the application and/or interview process should notify a representative of the organization.

APPLICATION FOR EMPLOYMENT

Name   
   Last  First  Middle  Telephone Number
Address
   Street  City  State  ZIP
E-Mail Address:
Are you 18 years or older?
 
      Position Applied For:
*
Salary Expectations:
      Date Available to Start:
If hired, are you willing to submit to and pass a controlled substance test?

Proof of eligibility documentation must be provided at time of hire as required by law.
If hired, are you willing to submit to and pass a background screening?
Are you able to perform the essential functions of the job for which you are applying, either with/without reasonable accommodation?
If no, describe the functions that cannot be performed
ARE YOU LEGALLY AUTHORIZED TO WORK IN THE UNITED STATES
 
*Have you ever been convicted of a felony?
*A conviction is not an automatic bar to employment. The type, seriousness, frequency of violations, recency, relevancy, work history, education and other circumstances will be considered.
If yes, list the court involved unless the record has been sealed
Describe Circumstances
City
State
County
Year
How did you learn of this position
MILITARY
 
Have you ever served in the U.S. Armed Forces:
From (Date): To (Date):
Branch of Service
Briefly describe service duties as they relate to the position for which you are applying:
Applicants who require reasonable accommodation for the application and/or interview process should notify the Human Resources Coordinator.

EDUCATION
High School:
Did You Graduate?
Years Completed
 
Course of Study :
Diploma / Degree / Certificate:
 
College, University or Technical College :
Did You Graduate?
Years Completed
    
Course of Study :
Diploma / Degree / Certificate:
 
Graduate School :
Did You Graduate?
Years Completed
 
Course of Study :
Diploma / Degree / Certificate:
 
Other :
Did You Graduate?
Years Completed
 
Course of Study :
Diploma / Degree / Certificate:


ALL APPLICANTS
LIST COMPUTER AND OFFICE EQUIPMENT SKILLS:
TECHNICAL APPLICANTS ONLY
LIST UTILITY OPERATION EQUIPMENT SKILLS:


EMPLOYMENT HISTORY
Even if you have attached a resume, this section must be completed

Present or most recent position first - a resume or addendum listing additional employers can be attached in Step 2

Name of Employer:
Address:
Telephone Number:
Position:
Dates Employed:
From: To:
Name and Title of Supervisor :
Reason For Leaving:
Brief Description of your Work and Responsibilities :
May We Contact this Employer?    YES

Name of Employer:
Address:
Telephone Number:
Position:
Dates Employed:
From: To:
Name and Title of Supervisor :
Reason For Leaving:
Brief Description of your Work and Responsibilities :
May We Contact this Employer?    YES

Name of Employer:
Address:
Telephone Number:
Position:
Dates Employed:
From: To:
Name and Title of Supervisor :
Reason For Leaving:
Brief Description of your Work and Responsibilities :
May We Contact this Employer?    YES

Name of Employer:
Address:
Telephone Number:
Position:
Dates Employed:
From: To:
Name and Title of Supervisor :
Reason For Leaving:
Brief Description of your Work and Responsibilities :
May We Contact this Employer?    YES

SPECIAL SKILLS/ADDITIONAL TRAINING
Please summarize any special job-related skills and qualifications from employment, other education, or volunteer experiences, etc. (Do not include experiences which would indicate race, color, religion, creed, sex, sexual orientation, national origin, marital status, Veterans status, status with regard to public assistance, membership or activity in a local commission, disability, or age).
References
Please provide the names of three business references that are not related to you. If you do not have any employment related
references, please list individuals who can comment on your work skills.
Name Phone Number E-mail Address Years Known and in what Capacity?
APPLICANT: Please read the following carefully before submitting this application.

I CERTIFY THE INFORMATION GIVEN BY ME IS TRUE IN ALL RESPECTS. I UNDERSTAND THAT THE MISREPRESENTATION OR OMISSION OF FACTS ON THIS APPLICATION, ON MY RESUME OR DURING ANY STAGE OF THE HIRING PROCESS WILL ELIMINATE ME FROM FURTHER CONSIDERATION OR IF DISCOVERED AFTER HIRE MAY RESULT IN THE TERMINATION OF MY EMPLOYMENT.

I UNDERSTAND THAT THE INFORMATION CONTAINED IN THIS EMPLOYMENT APPLICATION OR MY BEING INVITED TO PARTICIPATE IN ANY STAGE OF THE HIRING PROCESS IS NOT INTENDED TO CREATE AN EMPLOYMENT CONTRACT BETWEEN MIDWEST ASSISTANCE PROGRAM (MAP) AND MYSELF. IF AN EMPLOYMENT RELATIONSHIP IS ESTABLISHED, I UNDERSTAND THAT I HAVE THE RIGHT TO TERMINATE MY EMPLOYMENT AT ANY TIME, FOR ANY REASON OR NO REASON, WITH OR WITHOUT NOTICE, AND MIDWEST ASSISTANCE PROGRAM HAS THE RIGHT TO TERMINATE MY EMPLOYMENT AT ANY TIME, FOR ANY REASON OR NO REASON, WITH OR WITHOUT NOTICE. THE COMPANY’S POLICIES AND PROCEDURES, INCLUDING EMPLOYMENT AT-WILL, CANNOT BE MODIFIED IN ANY WAY WITHOUT EXPRESS WRITTEN INTENT TO DO SO BY THE CHIEF EXECUTIVE OFFICER.

I AUTHORIZE THIS COMPANY AND ITS REPRESENTATIVES TO CONTACT MY PRIOR EMPLOYERS, FORMER SUPERVISORS AND COMPANY, PERSONNEL, SCHOOLS AND ALL OTHERS FOR THE PURPOSE OF VERIFYING THE INFORMATION I HAVE SUPPLIED DURING THE SELECTION PROCESS AND FOR OBTAINING JOB-RELATED INFORMATION REGARDING MY KNOWLEDGE, SKILLS, ABILITIES, PERFORMANCE OF DUTIES AND COMPLIANCE WITH POLICIES. I AUTHORIZE MY PRIOR EMPLOYERS TO PROVIDE MAP WITH ANY JOB-RELATED INFORMATION, PERSONAL OR OTHERWISE, THEY MAY HAVE REGARDING ME. I RELEASE MAP AND THEM FROM ANY LIABILITY RESULTING FROM THE RELEASE OF THIS INFORMATION. I FURTHER AUTHORIZE ALL EMPLOYERS, SCHOOLS, AND OTHER PERSONS TO PROVIDE ANY INFORMATION OR TRANSCRIPTS THAT MAY BE REQUESTED BY MAP WHICH WILL BE USED TO DETERMINE IF I AM QUALIFIED TO PERFORM THE JOB DUTIES FOR WHICH I AM APPLYING.
 

Digital Signature:    Date:
  

Midwest Assistance Program, Inc., is an equal opportunity employer. Applicants who require reasonable accommodation for the application and/or interview process should contact MAP’s Director of Administration