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City of Ramsey <br />APPLICATION FOR EMPLOYMENT <br /> <br /> (PLEASE PRINT PLAINLY) <br /> <br />i,~ '. , . .,,,,.- , ....... ; ,.: ,.' ; , ,, <br />PERSONAL rote: <br /> <br /> ~ Fi~t Midge Inlti~ <br /> <br /> No. S~ ~ [ ~te <br /> <br />How many y~ have you liv~ at this ~dr~s? /7 ~ Telephone No. (~l~) ~ [ "~7/ <br />Previous addre._ ~/~ ~ ~,cl P.,,'~ ~oks ~ff ~raO3How long did you live there?. <br /> No. St~ Ci~ State ~p <br /> <br />Job(s) applied for 1. /~OI,'C~_ Cg ~ J~', .(_j~z~, Rate of pay expected $ per <br /> <br /> 2. Rate of pay expected $. per <br />How did you learn of this opening? U),'ll,'~,,~ <br /> <br />Do you want to work [~ Full-Time or [] Part-time. Specify days and hours if part-time- <br />liave you worked for us before? . /~O If yes, when? <br /> o~,'/l,'~,~-. Go.Z," ,',..,/.. <br />List any friends or relatives working for us <br /> <br />If hired, on what date will you be available to start Work? <br />Are Lhere any other experiences, skills, or oualifications which <br /> <br />~ ,~,~e d,'. 1~ I v <br />you feel would especially fit you for work with the Company? <br /> c, P iO0~ 7-- '(bO~,~,.(~ ? <br /> - <br /> <br />If hieed, do you have a reliable means of transportation to get to work? ...... c~¢.~ ... <br /> <br />Do you have any physical handicaps which would prevent you from performing specific kinds of work? <br />describe the defect(s) and explain the work limitations. <br /> <br />If yes, <br /> <br />Have you had a serious illness in the past 5 years? [] No <br />Have you ever received compensation for injuries? [~] No <br /> <br />[] Yes .(describe) <br />[] Yes (explain) <br /> <br />Have. you ever been convicted of a crime, excluding misdemeanors find summai'y offenses? <br />If yes, describe in full <br /> <br />[~ No [] Ye~ <br /> <br />Name hop ,'.5 ~f .~..q~/ Phone Number ('/~L / .7 ) 7".~' .... j <br /> <br /> <br />