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'. ,City of Ramsey <br /> <br />'APPLICATION FOR EMPLOYMENT <br /> <br />(PLEASE .PRINT PLAINLY) <br /> <br />IPERSONAL <br /> <br />Date: ~-' /'-~ °<2"3 <br /> <br />Social Security No. ~'1 -/3 - .~Y -/:~2._ <br /> <br />State <br /> <br />IHow many years have you lived at this address? <br /> <br />iPrevious address .~ro t '4-/¢~o$ /0 <br /> No. Strut <br /> <br /> Job(s) applied for 1. k ct.'l.-~ c; re.. e t~ <br /> <br /> How' did you learn of this openl/ig? <br /> <br />~te of ~y ex~t~ } ..... ~r <br /> <br /> Do you want to work [] Full-Time or [] Part-time. Specify days and hours if Part-time. <br />IHave you worked for us before? NI © If yes, when? <br /> List any friends or relatives working for us ~_~ o._ v ~..~..2- ~ ~, ~ T~I~g-'~ - <br /> <br /> If hired, on what date will you be available to start work? ~1' ~,o '~., ~,, o ¢. ~o <br />late there any other experien'ces, skills, or qualifications which you feel would especially fit you for work with the Company? <br /> _ , / / ', ,, , .. <br /> <br /> ~.z. so h r,.,-,,,. ~'~,..,,~,,-,,_,~f ~.7- .'ZZ,~c/r,~:,,o /.,,,-. , .s-.r.,,z;. ~;.~ 7-,. <br />I , . / - ~- <br /> <br />lIf hired, do you have a reliable means of transportation to get to work? "'1 ¢' % h q 5~ fL <br /> <br /> Do you have any physical handicaps which would prevent you from performing specific kinds of work? <br /> <br />Idescribe the defect(s) and explain the work limitations. <br /> <br />, If yes, <br /> <br />I Have you had a serious illness in the past 5 years? [] No <br /> <br />[] Yes (describe) <br /> <br />IHave you ever received compensation for injuries? [] No <br /> <br />[] Yes (explain) <br /> <br /> Have. you ever been convicted, of a crime, excluding misdemeanors and summary offenses? <br />I If yes, describe in full <br /> <br />[] No [] Yes <br /> <br /> <br />