Employee Application

Focus on Living, Inc. appreciates your interest in a position with our company. An incomplete application may reduce your opportunity for employment with the company. You are encouraged to attach any additional information which you believe qualifies you for the position.

Focus on Living, Inc. is committed to the policy that all persons shall have equal access to its programs, facilities and employment without regard to race, creed, religion, color, sex, age, marital status, national origin, disability or sexual orientation.

Position Applied For

Desired employment type

Applicant Information

Name
Address

Eligibility

Are you 18 years of age or older?
Are you a U.S. citizen, or if not, do you have permission to work in this country?
Have you ever worked for this company?
Month and year
Are you related to anyone currently working in any position with Focus on Living (full-time or part-time)?
Have you had any convictions for which a jail sentence was, or could have been, imposed?
Have you ever been convicted of any crime, including sex-related or child-abuse-related offenses?
Your answers will not necessarily bar you from employment with the company. Circumstances of conviction(s) will be taken into consideration. In determining if a conviction relates to the position sought, the hiring authority shall consider the requirements of Minnesota Statute 364.
Is there any reason you cannot be at work on time every day?

Employment History

List your present or most recent experience first. Do not state "see resume."
Employer 1 – May we contact this employer?
Employer 2 – May we contact this employer?
Employer 3 – May we contact this employer?
Have you ever been terminated by a previous employer?
Do not include lay-off or staff reduction.

Personal References

Education

Certifications

Check the current certifications you hold

Licenses

Do you have a valid driver's license?

Military Service

Supervision

Have you ever supervised people?
Check the functions you have performed as a supervisor

Summary

This section must be completed.

Read Carefully and Sign

Focus on Living has the right to verify information provided in the application. False information or omitting information may subject an applicant to the penalty provisions of Minnesota Statute 43A.39. I certify that all of the facts as set forth in this Application for Employment are true and complete. I understand that false statements or omissions on this application shall be sufficient cause for rejection of my application or dismissal if I am hired.

Unless otherwise indicated above, Focus on Living is hereby authorized to conduct an inquiry into all statements contained in this application or made during my interview for employment as may be necessary, including, but not limited to, 1) former employers for information concerning my employment, ability, experience and behavior on the job, and 2) my records maintained by an educational institution relating to academic performance such as transcripts. Moreover, I hereby release Focus on Living, and any such employers and individuals from any and all liability for damages whatsoever that may arise from furnishing this information.

I understand that as part of my employment application Focus on Living will be conducting a background check. I understand this check involves a computerized history check through the State of Minnesota and St. Louis County to insure there are no felony, gross misdemeanor or misdemeanor convictions, a warrant check to insure there are no warrants for arrest, and a driver's license check through the State of Minnesota to ensure that I have a valid driver's license and the status of my driving record. The county and state licensing offices mandate these background studies.

Certification and authorization

Important Facts About Information on Your Application

In accordance with the Minnesota Government Data Practices Act, Minnesota Statute 13.04, Subd. 2, Focus on Living is required to inform you of your rights as they pertain to private data collected from you. Private data is that information which is available to you, but not to the public. When you are asked to provide private data, Focus on Living must advise you of:

  • The purpose and intended use of the data;
  • Whether you may refuse or are legally required to supply the requested data;
  • Any known consequences arising from your supplying or refusing to supply the data; and
  • The identity of other persons or organizations authorized by State or Federal law to receive the data you provide.

The following information you provide for employment is automatically public: your veteran's status, work availability, your job history, and your education and training.

Minnesota Data Practices Act

I understand that nothing in this employment application is intended to lead to or create an employment contract between Focus on Living and myself. I further understand that no Focus on Living employee has the authority to enter into an employment agreement for any specified period of time. I further understand and agree that Focus on Living may terminate the employment relationship that may result from my application at any time.

Acknowledgment
Type your full legal name.