6739 Golden Valley Rd
Golden Valley, Minnesota 55427
Hugh.Aylward@kellynorton.org





Oasis Program:   763-544-1447
Bill Kelly House:  612-726-1502
Stevens House:   612-872-9035



Application for Employment


We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, diability, marital or veteran status, or any other legally protected status.


 
GENERAL INFORMATION
 
 
Date:
 
Which facility are you applying for? (Check all that apply)
  Stevens House Bill Kelly House Oasis Program

 

Your Email Address: *
 
Best time to contact you at home is: : AM PM
 
Have you ever filed an application with us before?
   If Yes, give date:
Yes No
 
Have you ever been employed with us before?
   If Yes, give date:
Yes No
 
Do any of your friends or relatives work here? Yes No
 
Are you currently employed? Yes No
 
May we contact your present employer? Yes No
 
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
   Proof of citizenship or immigration status will be required upon employment
Yes No
 
Date available for work:
 
What is your desired salary range?
 
Are you available to work:
Full-Time Please indicate: Day Evening Overnight
Part-Time Please indicate: Day Evening Overnight
Temporary Please indicate:
 
Are you currently on "lay-off" status and subject to recall? Yes No
 
Can you drive the work van if needed? Yes No
 

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

 
EDUCATION
 
  Name & Address of School Course of Study Years Completed Diploma / Degree
High School
Undergraduate College
Graduate / Professional
Other (Specify)
 
 
 
EMPLOYMENT EXPERIENCE
Please start with your present or last job
 





Dates Employed
FromTo
Hourly Rate/Salary
StartingFinal
Work Performed

 





Dates Employed
FromTo
Hourly Rate/Salary
StartingFinal
Work Performed

 





Dates Employed
FromTo
Hourly Rate/Salary
StartingFinal
Work Performed

 





Dates Employed
FromTo
Hourly Rate/Salary
StartingFinal
Work Performed

 
 
 
 
Are you capable of performing in a reasonable manner, with or without reasonable accommodation, the activities involved in the job or occupation for which you have applied? A review of the activities involved in such a job or occupation has been given. Yes No
 
REFERENCES
 
 
 
 
APPLICANT'S STATEMENT
 

I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employement as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicatble law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of the organization.

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 employer.

 

   Date: