Laura Baker Services Association

Job Application

Use your “tab” key to navigate down the form. Using the “enter” key in areas outside of text field questions will prematurely submit your application.

Name:
Current Address
Permanent Address

Home Phone Number

Mobile Phone Number
Work Phone Number
E-mail Address

Position(s) Desired

Date You Can Start

Salary Desired
Hours You Can Work
Are you presently employed?

Yes
NoHave you ever applied to Laura Baker Association?

Yes
NoReferred By :
How and where do you prefer to be contacted?

Education :

High School name and location

Number of years attended
Degree Earned
College/University name and location

Number of years attended
Degree Earned
Majors or subjects studied
Other Educational Institute name and location

Number of years attended
Degree Earned
Majors or subjects studied
Other Specialized Training, Education or Research Work:

Minnesota Licenses or Certificates:

List all present and past employment, beginning with most recent. Please include name and address of company, start date, end date, title and major responsibilities, full time or part time, starting salary, ending salary, reason for leaving, and supervisor’s name and telephone number.

May we contact the employers listed above?

Yes

No (If not, please indicate which ones we may contact in your list.)References:
Give below the names of three persons who are not related to you, whom you have known for at least one year and who are acquainted with your professional abilities. Send these individuals your written authorization to release information to the Laura Baker Services Association. If you are registered with a placement office, please ask them to forward your credentials immediately.
What do you see as the ?special? needs of individuals who are developmentally disabled?

Please answer the above question in a complete and concise manner.

Please review your application before submitting as once submitted no changes can be made. If you have any questions or concerns pertaining to your application, please contact Delcie at (507) 645-8866 x 126

After submitting your completed application, three completed copies of this information release form need to be sent to Delcie at Laura Baker Services before your hire can be completed. Additionally, one completed copy of this affirmative action form would be appreciated, however is not mandatory.