First Name *

Last Name *

Street address *

City *

State *

Zip Code *

Position applied for: *

Where did you hear about this position?

Gender:

With which racial/ethnic group do you identify?

**American Indian defined as: “A person of one quarter or more Indian blood.” (Minn. Stat. 254.02, Subd. 11). The Minnesota Indian Affairs council suggests at hire, state agencies require persons claiming Indian heritage to provide an enrollment number and tribal affiliation.

Do you claim disability status?

Disability Status is defined as a physical or mental impairment that substantially limits one or more of the major life activities, has a record of such impairment or is regarded as having such an impairment.

Do you qualify for Veterans Preference?

To qualify you must meet all of the following:
1) Have separated under honorable conditions from any branch of the armed forces of the United States;
2) Have served on active duty for 181 consecutive days or more OR for the full period ordered to active duty OR have separated by reason of disability incurred while serving on active duty;
3) Be a United States citizen OR resident alien.

Do you need special testing accommodations such as a reader

or sign language interpreter?

If yes, please specify type of accomodation needed: