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02-23-15-R
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02-23-15-R
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2/20/2015 5:38:44 PM
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1 <br />Employment of Relatives <br />List any relatives currently employed by the City of Arden Hills <br />Name Relationship To You l <br />Personal References <br />Not former employees or relatives) <br />Name and Occupation Address Phone Number <br />Tennesseen Warning/Data Practices Notice to All Applicants <br />The Minnesota Government Data Practices Act requires that you be informed of the purposes and intended uses of the information you <br />provided to the City of Arden Hills during the application process or during employment. Any information about yourself that you provide will <br />be used to identify you as an applicant and to assess your qualifications for employment with the City. if you wish to be considered for <br />employment, you are required to provide the information requested in the Application for Employment. If you refuse to supply information <br />requested by the City,it may mean your application will not be considered. <br />You are hereby advised that, under Minnesota law,the following information given by an applicant is considered to beup blic: veteran status, <br />relevant test scores,rank on our eligible list;job history;education and training;work availability. <br />As an applicant, your name is consideredrip vate until you are certified as eligible for appointment to a position or when applicants are <br />considered by the appointing authority to be finalists for a position with the City of Arden Hills. "Finalist"means an individual who is selected <br />to be interviewed by the appointing authority prior to selection. <br />The data concerning you,which is placed in your application folder or in your personnel file and which is not listed as public,is private. This <br />private date will be shared with you and those members of the City staff who need it to process the application,update your personnel record, <br />evaluate your work performance and if you are handicapped,provide the necessary accommodations. It may also be shared with the following: <br />persons authorized to have access to the information under State or Federal law; persons authorized by Court Order to have access to the <br />information;and persons to whom you consent in writing to have access to the information. <br />With the exception of racial and ethnic data, the data you give us about yourself is needed to identify you and to assist determining your <br />suitability for the position for which you are applying. Racial and ethnic data used in summary form by the City's Affirmative Action Program <br />to monitor protected class employment and to meet Federal, State, and Local reporting requirements. Furnishing racial and ethnic data about <br />yourself,as well as your social security number,is voluntary. <br />I certify that answers herein are true and complete to the best of my knowledge. <br />I authorize investigation of all statements contained in this Application for Employment as may be necessary in arriving at an employment <br />decision. I understand that this application is not,and is not intended,to be a contract for employment. <br />In the event of employment,I understand that false or misleading information given in my application,or interview(s),may result in discharge. <br />I understand also,that I am required to abide by all rules and regulations of the City. <br />I certify that I have read the"Notice to Application"regarding the Minnesota Data Practices Ace(MN Statutes 1301-1390), and I understand <br />my rights as a subject of date. <br />Applicant Signature: Date: <br />Dave Perrault 1/05/2015 <br />City of Arden Hills* 1245 West Highway 96, Arden Hills, MN 55112 *(651)792-7800
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