Employment Application for Key Employees



Employment Application | |

|Position Applied For: |Today’s date: |Date you can start: | |

|First Name |Last Name & Middle Initial |Phone # |

|D.O.B. |Drivers License #: |S.S.N. |

|Address |City, Sate, Zip |

|Please list your last three employers. (Beginning with most current): |

|May we contact current Employer? |Yes / No / Explain | |

|Business Name | |Supervisor: |

|Address Phone #: |

|Please list your responsibilities: |

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|Start Date: |Ending Date: |Salary: |

|Business Name | |Supervisor: |

|Address Phone #: |

|Please list your responsibilities: |

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|Start Date: |Ending Date: |Salary: |

|Business Name | |Supervisor: |

|Address Phone #: |

|Please list your responsibilities: |

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|Start Date: |Ending Date: |Salary: |

|Personal References: | | |

|Name |Address |Phone # |

|Name |Address |Phone # |

|Name |Address |Phone # |

|Name |Address |Phone # |

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|List the city state of all addresses within the past ten years: |

|ADDRESS & CITY |STATE |FROM (date) |TO (date) |

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|Are you legally entitled to work in the United States? | | Yes / No | |

|Have you ever been convicted of a crime? | Yes / No | |

|Do you have any of the following licenses: |Number |State of Issuance |

|( Drivers License | | |

|( Boiler / Engineer’s License | | |

|( Contractor’s License | | |

|( Real Estate License | | |

|( Other: | | |

|CONFIRMATION OF INFORMATION ACCURACY AND RELEASE AUTHORITY TO VERIFY |

|I hereby certify that the information in this application is correct. I understand that I am applying for a job that will give me keys and unsupervised |

|access to the apartments and personal belongings of the employer’s customers. The information included in this application is for use by employer in |

|determining my suitability for employment. I understand that, if I am offered employment, the employer may utilize investigative sources which it |

|considers necessary in making this determination, including credit reporting agencies, public record repositories, and licensed investigative agencies. |

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|According to Minnesota Law, I understand that I have the following rights: 1)The right to be informed that the owner will request a background check on |

|the caretaker (applicant) to determine whether the caretaker has been convicted of a crime specified in section 299C.67, subdivision 2,2) the right to |

|be informed by the owner of the superintendent’s response to the background check and to obtain from the owner a copy of the background check report, 3)|

|the right to obtain from the superintendent any record that forms the report, 4) the right to challenge the accuracy and completeness of information |

|contained in the report or record under section 13.04, subdivision 4, and 5) the right to be informed by the owner if the caretaker’s application to be |

|employed by the owner or to continue as an employee has been denied because of the result of the background check.” |

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|SIGNATURE OF APPLICANT |DATE |

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