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PlCdse rctwo to t11Y OF ORONO <br />BOX66 Date Received <br />CRYSTAL BAY, MINN. 5023 <br />CITY OF ORONO II 615A3 D <br />J. <br />I__.. <br />APPLICATION FOR EMPLOYMENT <br />I <br />Dear Applicant, <br />We welcome you as an applicant for employment. Your application will be considered with others. <br />It is our policy to provide equality of opportunity in employment. This policy prohibits discrimination <br />on the basis of race, Fofor, religion, national origin, political affiliation, disability, marital status, sea or <br />age (between 40 and 65) in all aspects of our personnel policies, programs, practices and operations. This <br />Policy apply to full, part-time, temporary, and*asonal employment. <br />The Information contained in this application will be considered personal and confidential and used <br />only in conjunction with your possible employment. Please furnish us with complete information. You <br />are encouraged to attach any additional information which you believe qualifies you for the position. <br />Please use INK OR TYPEWRITER. <br />1 Title or Kind of work applied for: r — Permanent —. part-time a ate dab <br />-- Temporary —Seasonal / A, t1t/if) <br />2. PERSONAL INFORMATION <br />i 3. Name Last First Middle Social Securit No. <br />f _ LPN Q a�aia ay <br />4. Present Address City County. State Zip Code <br />5. Home Phone <br />6. Do you have any Physical or Health limitations <br />Work Phone No, <br />411 0111 <br />affect your work performance? <br />Yes <br />If you have answered yes, please use an additional sheet to explain. <br />7. If you an not a citizen of the United States, do you have Bureau of Immigration approval to work <br />In the U.S.? Yn No N/R <br />EDUCATIONAL INFORMATION (To be completed only if education is a job requirement) <br />IL Circle the highest Grade School High'"�hoof College Bost Graduate A <br />' grade completed 1 2 3 4 5 6 7 O 9 10 1 IC7rGED 13 14 15 16 MA Phd I . <br />