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<br /> -T1.LWc.l . -;....~~:~...-t ( 3 ~ ':;;0 <br /> APPLICATION FOR EMPLOYMENT <br /> . CITY OF ARDEN HILLS <br /> 1450 W. HWY. 96 <br /> ARDEN HILLS, MN 55112 <br /> (612) 633-5676 <br /> PLEASE TYPE OR PRINT CLEARLY <br /> 1. Severtson. Cynthia , Lee <br /> NAME (Last, First, Middle) <br /> 2. 71)00 J\lpwrnn l\VPnllP Nortn: RrCY"lkl1m P.::lrkt. /VIN l::,S444 H::::.nnipi-n n.....l1T1ty <br /> ADDRESS (Street, City, State, Zlp Code County) <br /> 3'~12) 561 4879 561 5448 <br /> H'.-<ME PHONE NtJMBER I-JORK }?HONE NLTNBER <br /> ~. "Rpr-n::'rit i nil Prrgrrim Sl1pp1\7i snr <br /> TITLE OF POSITION YOU ARE APPLYING FOR <br /> 5. "Anyt-imp Yes <br /> DATE AVAILABLE U.S. CITIZEN (Yes or No) <br /> 6. f~.Y WE ASK YOUR PAST AND PRESENT ill1PLOYER(S) ABOUT YOUR QUALIFICATIONS? <br /> YES Yes, please do NO <br /> -- .~~. <br /> . 'I, DO YUU ;.rAVE i\NY PHYSICAL OF HEJ..LTH LIf~ITATIONS \~HICH AFFECT YOUR \~OP.K <br /> ?ERFORNlu\lCE? YES NO X <br /> 8. CIRCLE THE LAST GRADE COMPLETED 7 8 9 10 11 12 13 14 15 G 17 <br /> 9. HIGH SCHOOL/COLLEGE EDUCATION: NN1E/LOCATION/ DATES ATTENDED/DEGqEES <br /> r~nby Hi9h School 1976 1983 <br /> Concordia ~nllp9P, Mnnrhp,qn . MN 1 9R"i-1 9R7 <br /> 10. LIST CURRENT LICENSES, REGISTRATIONS OR CERTIFICATES RELATED TO THE <br /> JOB FOR WHICH YOU ARE APPLYING. <br /> First Aid Certification Water Safety Instructor <br /> , <br /> CPR Instrnctor Certification, Volleyball Official ; <br /> 11. HAVE YOU EVER BEEN CONVICTED .~S Acloj ADULT FOR A CRIi-iINAL VIOLATION? <br /> YES NO X (IF YES, DATE AND PLAC~ <br /> . NATURE OF OFFENSE DISPOSITION i <br /> , <br /> i <br />