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The. information requested below relates to criminal convictions. Before any applicant is rejected on the basis of criminal <br /> conviction, he/she will be notified in writing and will be given any rights to processing of complaints or grievances <br /> afforded by Minnesota Statute Chapter 364. Applicants who are finalists will be subject to a criminal background <br /> investigation. <br /> (lave you ever been convicted of a crime for which a jail sentence of more than 90 days could have been imposed? <br /> Yes t <br /> If yes, date and place Nature of offense Disposition <br /> Date and Place Nature of offense Disposition <br /> TO BE COMPLETED BY APPLICANTS FOR CLERICAL AND ACCOUNTING POSITIONS ONLY <br /> Typing ability? yes no wpm Shorthand ability? yes no wpm <br /> Dictating equipment ability? yes no wpm Speedwriting ability? yes no wpm <br /> Personal computer/word processor ability? yes no type <br /> Other office equipment you can operate <br /> TO BE COMPLETED BY APPLICANTS FOR LABOR AND SKILLED TRADE POSITIONS ONLY <br /> Apprenticeships served or trades learned: <br /> Ca able of operating the following equipment: 52ift/4 t�iPli', 41_5744e/7 ✓/ G��/lj') <br /> �6ver' ' -t:) .5.L /,, 1 110e-- (T Pe - i ►m/p4O YIllc ' In cc <br /> Y <br /> EMPLOYMENT HISTORY <br /> LIST EMPLOYERS BEGINNING WITH PRESENT OR POST RECENT. PLEASE ATTACH ADDITIONAL EMPLOYMENT HISTORY YOU BELIEVE WOULD <br /> QUALIFY YOU FOR EMPLOYMENT WITH MOUNDS VIEW. <br /> PRESENT ORLAST a • . • ADDRESS D ..' CODE PHONE N <br /> In '- ' 1/- (:J c /th( , 2( c'/ Z/ 5?174 6 i"7e R-seotae_ : " 3 636' 366-0 . <br /> SUPERVISOR'S NAME AND TITLE MAY WE CONTACT?- c NO, PLEASE EXPLAIN <br /> 41 r ,. MAY <br /> . X07, �— /6 e . <br /> r <br /> EMPLOYMENT/DATES ofLAST SALARY 4110AgirTIP REASON FORM LEAVING JOB TITLE <br /> FROM 45--/ .5k; TO 44S /sill PART TIME `O-t "e4 U` Laiop ,. <br /> ci <br /> SPECIFIC DUTIES ,tn ( A/4 1 e6 of ew.-jt(f/r e 4L& /, (c'/7-Gt 1 39c,zt <br /> tar.)/74, Ga/r/4 4/e._ - Cl-e,vniei a f 4`/ -r--c,rr�i Itrgt.. e4 f--te - <br /> i 114004•0i c_Lcev,- - a)/71 D01.05 r iA//c - e 57a ' .&,v voL .r+#s''5 <br /> ('v Ill Li Q — (23 'A,E'.--, or)ii-s/ -- 'CJ7'/ - SPC,..,r 074' /3L L �, <br /> SECOND LAST ELF! YERADORES ZIP CODE PHONE N <br /> (;71,k) tffOR$ 102c /V ioc k) r Pr. 5-c/Q 4,45-- <br /> SUPERVISOR'S NAME AND TITLE MAY WE CONTACT? � IF NO PLEASE EXPLAIN <br /> Doi' I GI ter �iodcf i Spee, S C', moves 71-0 CO -, <br /> .- <br /> EMPLOYMENT DATES LAST SALARY r FULL TIME REASON FOR LEAVING/Ay O� JOB TITLE <br /> rnou (o/ 'Z TO g /V 5 /12 PART TIME Coy /2 v� ILO6+J"Sc 414r. 0,r°e2p <br /> SPECIFIC DUTIES M0i4-14e4Anc O14 P ocauGfc,vt /IJ'ACh in Pr"y — /&"?/ /i7#444rit 10s' <br /> ( / I3/V 0 1) /2 /'A <br />