How did you hear about us? Mid-Minnesota Management Services D.B.A. Central Resources 2700 1st St N Suite 303 St. Cloud, MN 56303 Telephone (320)253-8295 or Toll-Free (800)950-7188 Application for Employment Postion Applied For Date you can start Salary Desired Today's Date Social Security # First Middle Last Home Address City State Zip Phone # Alternate Phone # Email Are you 18 or older? NoYes If hired, can you furnish proof you are eligible to work in the United States? NoYes Ever been employed by Central Resrouces? (If yes, when?)NoYes Educational History Name of School/Location Did you graduate? Degree/Diploma Major Additional job related seminars, short courses, workshops, or educational experiences Military Background Branch of Service Military Occupation Rank at Discharge Specialized Training Work History Include all employment from your last three employers with start and end dates. If you have a gap of employment, please explain below, including dates. Failure to provide complete information may result in rejection of your application. May we contact your present employer? YesNo Present and Former Employers: List Most Recent First Company Name Job Title & Duties Final Wage Address City, State, Zip Supervisor's Name Phone # Dates Worked Reason for Leaving Company Name Job Title & Duties Final Wage Address City, State, Zip Supervisor's Name Phone # Dates Worked Reason for Leaving Company Name Job Title & Duties Final Wage Address City, State, Zip Supervisor's Name Phone # Dates Worked Reason for Leaving Special Skills & Qualifications Additional information you want us to consider in evaluating your qualifications Explain any gaps in employment here References Give the names of three individuals not related to you, whom you have known at least 1 year Name Business Phone # Years Known Agreement - Please read carefully entire statement below and sign I certify that the facts contained in this application are true and complete to the best of my knowledge andunderstand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damages that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.