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Town of Minden Administrative Offices 1604 Esmeralda Ave, Ste 101 Minden, Nevada 89423 www.townofminden.com (775) 782-5976 office – (775) 782-5287 Fax If you have a disability and believe you require special accommodations during the selection process, please contact the Town Administrative Offices to make the appropriate arrangements. Please answer each question completely. Please type or print clearly and legibly. Applications not filled out completely will not be considered. Return completed application to the Town of Minden Administrative Offices no later than April 19, 2024 by 4:00pm. Photocopies of this application will be accepted with an original signature. Faxed copies are accepted by the deadline date at (775) 782-5287. Resumes accepted when attached to a completed application. All information on the application is voluntary and could be released to the public. Date Mailing Email Address City Zip Code______ Telephone Cellular Phone On what date would you be available for work? Do you understand the job requirements for this position? Yes No Can you perform the requirements of this job with or without reasonable accommodations? Yes No Are you at least 18 years of age? Yes No If No, please state your age: Are you legally eligible to work in the United States? Yes No Following an offer of employment, you will be required to submit verification of your legal right to work in the United States. Are you a resident within the Town of Minden boundaries? Yes No Applicants who do not reside in the Town of Minden boundaries will be disqualified. Have you ever been discharged or terminated from any place of employment? Yes No If so, please NOTE: A termination conviction will not necessarily disqualify you from employment. It will be considered in terms of work to be performed. Town of Minden – Board Member Application List job-related Certificates/Licenses, Registrations or Training related to the position for which you are applying: Date Completed Town of Minden Board Member Application Received: ---PAGE BREAK--- EDUCATION RECORD Did you graduate from high school? Yes No If No, did you receive a GED certificate? Yes No Did you graduate from college? Yes No School Name and Location Units Major Study H.S. Diploma/Degree Earned High School College Trade/Business Graduate School MILITARY SERVICE Have you ever been a member of the Armed Forces? Yes No Discharge EMPLOYMENT HISTORY Provide information regarding all paid, military, and volunteer work within the past ten years. Describe your current or most recent position first; then list other relevant positions in order, working down from the most recent. Use a separate block for each position – even if employment was with the same organization. Use additional sheets if necessary. Do NOT use references such as “See Resume” in place of completing this section. Insufficiently completed applications will not be considered. Number of Employees Supervisor’s Related Reason for ---PAGE BREAK--- Number of Employees Supervisor’s Related Reason for Number of Employees Supervisor’s Related Reason for Number of Employees Supervisor’s Related Reason for May we contact all employers listed? Yes No (Attach a list of any exceptions with an explanation). Please state below any other information that would be helpful in determining your qualifications for this position. You may include significant accomplishments, previous career highlights, or any other information that is not included in this employment application. ---PAGE BREAK--- PERSONAL REFERENCES Give the name, address (home or business) and telephone number of three professional references NOT RELATED to you who have knowledge of your character, work experience, ability and accomplishments. Name Address Occupation Telephone AGREEMENTS Please READ ALL of the following statement. If you have questions, contact Town Administrative Offices (775) 782-5976. I hereby certify that every statement I have made in this application is true and complete to the best of my knowledge. I understand that I will have to verify any and all information given on this application. I understand that any misrepresentation, falsification or material omission of information may result in my failure to be considered. Signature of Revised 4/4/24 ---PAGE BREAK---