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Personal Information

High School
Address
College
Address
Major
Degree
Other Education
List any other vocational or on-the-job training you have completed which would be useful in the position you are applying for:
List any licenses or certifications you hold which are necessary or useful in the position. List issuing state and expiration date:
Are you qualified to perform the essential functions of the position listed in the job description with or without reasonable accomodation?*
1. Yes
2. No
If testing is required, will you need any accomodation for the testing process?*
1. Yes
2. No
3. N/A
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Name of Employer
Position
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date
Reason for leaving:
Name of Employer
Position
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Reason for leaving:
Name of Employer
Position
Name of Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Reason for leaving:
Name of Employer
Position
Name of Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Reason for leaving:
Upload Resume Here
While uploading a resume is not required, it is strongly recommended.
If you are having issues submitting a resume, please email it to ClerkRecords@cityofblaine.com.
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Include your cover letter here:
Upload cover letter here
While uploading a cover letter is not required, it is strongly recommended.
If you are having issues submitting a cover letter, please email it to ClerkRecords@cityofblaine.com.
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By signing this Application, I hereby certify that the facts set forth in this Application and supporting documentation are true and complete. I understand that failure to provide true and complete information on this Application and supporting documentation will be grounds for my immediate discharge. I authorize the City to investigate the statements made in this Application and supporting documentation, including work history. I release the City of Blaine, my previous employers, and their respective current and former representatives, from any and all liability arising out of their disclosure of, failure to disclose, or reliance on information about me disclosed or requested during the City's reference checks.
Applicant Signature*

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