First Name
Last Name
Phone
Email
Address
Address
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State
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AR
CA
CO
CT
DC
DE
FL
GA
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
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NY
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PR
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Date Available for Work
Position Desired
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Elem Paraprofessional
Are you interested in coaching/advisory positions?
Branch of Service
Type of Discharge
Community Work and Other Interests/Activities
Please upload your resume here.
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EDUCATION
Subjects of Social Study or Research Work
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Employment History
Starting with your present or most recent employer, please list your last four jobs. Do not omit any work experience.
Company
Phone
Address
Address
City
State
- -
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Zip
Supervisor's Name
Reason You Left:
Description of Duties
Company
Phone
Address
Address
City
State
- -
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Zip
Supervisor's Name
Reason You Left:
Description of Duties
Company
Phone
Address
Address
City
State
- -
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Zip
Supervisor's Name
Reason You Left:
Description of Duties
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List any special skills/qualifications you possess which are directly related to the position for which you are applying (ie: Clerical, Typing, Machines/Equipment):
Comments
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List three persons not related to you who have known you for at least a year, preferably job related.
#1
First Name
Last Name
Phone
Email
Address
Address
City
State
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AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Zip
Years Known
#2
First Name
Last Name
Phone
Email
Address
Address
City
State
- -
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Zip
Years Known
#3
First Name
Last Name
Phone
Email
Address
Address
City
State
- -
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Zip
Years Known
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AFFIRMATIVE ACTION SURVEY
Applicants are considered for all positions, and employees are treated without regard to race, color, creed, religion, national origin, sex, disability, age, marital status, or status with regard to public assistance.
As an employer, we comply with government regulations and affirmative action responsibilities. To assist us with government record keeping, reporting and other legal requirements, we ask that you fill out this survey. Providing this information is voluntary, and the information you provide will be kept confidential. Thank you.
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Minnesota Fraud Statue: Any person who, with intent to defraud, receives workers' compensation benefits to which the person is not entitled by knowingly misrepresenting, misstating, or failing to disclose any material fact is guilty of theft and shall be sentenced pursuant to section 609.52, subdivision 3.
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