Employment Application Anamoose ♦ Devils Lake Harvey ♦ Rugby ♦ Towner Personal InformationName(Required) First Name Last Name Date(Required) Physical Address(Required) Street Address City State / Province / Region ZIP / Postal Code Mailing Address Street Address City State / Province / Region ZIP / Postal Code Email(Required) Home Phone(Required)Cell Phone(Required)Employment DesiredPosition desired(Required)Date available to begin Have you previously applied for a position with this program?(Required) Yes No Were you referred to Early Explorers by a current staff member?(Required) Yes No If yes, who:Are you currently certified in CPR?(Required) Yes No Are you currently certified in First Aid?(Required) Yes No Do you have a current TB screening(Required) Yes No Do you have a current and valid ND driver’s license?(Required) Yes No Educational BackgroundLevel(Required) High School GED Name/Location of school(Required)Years(Required)Graduate?(Required) Yes No Degree/Focus(Required)College/University:Name/Location of schoolYearsGraduate? Yes No Degree/FocusTrade/Business/ Correspondence School:Name/Location of schoolYearsGraduate? Yes No Degree/FocusOther:Name/Location of schoolYearsGraduate? Yes No Degree/FocusGeneral InformationSubjects of special study, training, and skills(Required)Employment HistoryDates from/to1. Most Recent EmployerSalaryPositionReason for LeavingDates from/to2. EmployerSalaryPositionReason for LeavingDates from/to3. EmployerSalaryPositionReason for LeavingPersonal References Please provide the names of three persons, not related to you, and whom you have known for at least one year who can prove a personal character reference upon our contact.Name(Required)AddressPhone Number(Required)Years KnownName(Required)AddressPhone NumberYears KnownName(Required)AddressPhone Number(Required)Years KnownAuthorization(Required) I certify that the information contained in this application is true and complete to the best of my knowledge. I understand that any falsified statements may be the grounds for dismissal. I authorize investigation of all statements contained including references and employers listed.Signature of Applicant(Required)Date
