Application for Employment

BACKGROUND INFORMATION

EDUCATIONAL BACKGROUND

EMPLOYMENT HISTORY (Please list all previous employers for the past five years with most current first.)

REFERENCES

(Please list 3 references, at least 2 of which are current or former supervisors)

By signing this application, I certify that everything I have written here is true to the best of my knowledge. I understand that I can be terminated if the information found herein is proved to be false.

Note:  Due to the nature of the services Evergreen provides to vulnerable youth and young adults, employment is contingent upon successfully passing a Minnesota Department of Human Services Applicant Background Study, a Minn. BCA web-based check, a National Sex Offender check, as well as a Sexual Contact Background Study and reference checks.

An Equal Opportunity, Affirmative Action Employer.

 

Applicant Flow Survey Form

 These questions are optional.

 

Please read carefully:

 

Evergreen Youth & Family Services, Inc. is an equal opportunity employer and does not discriminate in hiring or employment on the basis of race, creed, color, religious affiliations, sex, sexual orientation, national origin, age, disability, status with regard to public assistance, marital status, familial status, or any basis prohibited by federal, state, or local law. No question on this form is intended to secure information to be used for such discrimination. Evergreen is required by federal regulation to report information as requested below. Your completion of this survey is completely voluntary and in no way affects the decision regarding your employment opportunity. The information you provide is strictly confidential and will be maintained separate from your application/resume.

 

*This form is not used for employment decisions.  If you have a disability and need an accommodation so that you can perform the duties of the job for which you are applying, or if you need accommodations during the application or interview process, please notify the Human Resources Director at (218) 441-4558.