Employment Application

Personal Information

Name(Required)

First Middle Last

Address(Required)

Street Address Apartment/Unit # City State ZIP Code

Phone(Required)

Email(Required)

Date Available

Position Applied For:(Required)

Desired Salary(Required)

Are you a citizen of the United States?(Required)

Yes

If no, are you authorized to work in the U.S.?(Required)

Yes

Have you ever worked for this company?(Required)

Yes

If yes, when?(Required)

Have you ever been convicted of a felony?(Required)

Yes

If yes, explain:(Required)

Education

High School

Name & Address of School

Years Attended

Did you graduate (Yes/No)?

Diploma

College

Name & Address of School

Years Attended

Did you graduate (Yes/No)?

Diploma

Other

Name & Address of School

Years Attended

Did you graduate (Yes/No)?

Diploma

References

Please list up to two professional references.

First Reference

Full Name

Relationship

Company

Phone

Address

Second Reference

Full Name

Relationship

Company

Phone

Address

First Previous Employer

Company

Phone

Address

Supervisor

Starting Salary

Ending Salary

Job Title

Responsibilities

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes

Second Previous Employer

Company

Phone

Address

Supervisor

Starting Salary

Ending Salary

Job Title

Responsibilities

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes

Third Previous Employer

Company

Phone

Address

Supervisor

Starting Salary

Ending Salary

Job Title

Responsibilities

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes

Military Service

Branch

From:

To:

Rank at Discharge

Type of Discharge

If other than honorable, explain:

Maintenance Technician Supplemental Application Form

Do you currently possess a valid MN Driver’s license?(Required)

Yes

Do you have a high school diploma or equivalent?(Required)

Yes

Do you currently possess a MN boilers license?(Required)

Yes

If yes, please list the certification information.(Required)

Do you have vocational or technical training?(Required)

Yes

If yes, please describe and attach a copy of degree achieved.(Required)

How many years of experience do you have with maintenance or carpentry work?(Required)

9 or more years

6-8 years

3-5 years

1-2 years

Less than 1 year

Describe your experience with plumbing, electrical, appliance repair and carpentry:(Required)

Describe your experience with snow plowing:(Required)

Are you available to work over-time and commit to long hours of work when necessary?(Required)

Yes

Have you ever received formal safety training in how to operate and maintain equipment, which many include things such as proper safety/ “circle check” of the vehicle, worksite inspection, fall hazards, use of fall protection, and tip-over, collision, or electrocution hazards?(Required)

Yes

Do you have experience working for a city, HRA, or local government agency?(Required)

Yes

If yes, list name of entity:(Required)

Describe your experience with customer service:(Required)

After reading the job description, are you able to perform the essential functions and meet the physical demands associated with this position with or without reasonable accommodations?(Required)

Yes

Why do you want to work for the HRA of Mora?(Required)

How did you hear about this job opening?(Required)

Disclaimer and Signature

Type Name for Signature(Required)

Date(Required)

P.O. Box 209
160 Valhalla Circle
Mora, MN 55051

Monday-Friday
8:00am-4:00pm
Saturday-Sunday
Closed

Life Enrichment Center

Eastwood Life Enrichment Center
Facilty Rental Application

160 Valhalla Circle, Mora, MN 55051
Phone: 320-679-4789

Company/Organization/Group(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Contact Phone(Required)

Contact Email(Required)

Date requested for event(Required)

Rental Rates

$20 per hour, 4-hour minimum +$100 refundable deposit

Total facility time begin(Required)

Total facility time end(Required)

Actual event time begin(Required)

Actual event time end(Required)

Calculate hours x $20 and enter total amount(Required)

The applicant is responsible for informing members of their group of their duties / responsibilities under policies

1.

It is understood and agreed that the Mora HRA Boards, employees, volunteers, and agents shall be held harmless against all claims, damages, loss or expenses including attorney’s fees arising out of or resulting from the use of the Eastwood Life Enrichment Center and surrounding areas.

2.

Each group shall be fully responsible for the physical condition in which they leave the facility. Expenses resulting from any damage or undue maintenance shall be charged to the applicant and taken from deposits. Failure to meet any obligations beyond deposit amount within thirty (30) days of billing will be cause for cancellation of future privileges and for legal action including all costs incurred for collection.

3.

Alcohol shall not be permitted to be served in the facility without the approval of the HRA Board of Directors and the express written consent of the HRA Executive Director.

4.

I have read, understand, and agree to comply with all the rules, regulations, policies, and fee schedules, as set forth by the Mora HRA. I further attest that I will be personally responsible for repair or damage to equipment, the facilities, and grounds or for replacement of stolen equipment.

Hold harmless agreement(Required)

I agree to be responsible for the conduct of our group in and about the facilities in use, for the control and containment of noise, group participants, litter and damage beyond ordinary wear and tear, which may occur while we are occupying the premises. I further agree that use of the Eastwood Life Enrichment Center shall be in accordance with Policies and Procedures, local ordinances and all valid laws of the State of Minnesota. It is understood and agreed that the HRA, its Boards, employees, volunteers, and agents shall be held harmless against all claims, damages, loss or expenses including attorney’s fees arising out of or resulting from the use of this facility.

Age(Required)

I am over 21 years of age *

Policies(Required)

I agree to adhere to all policies set forth by HRA, and acknowledge my deposit may be kept to pay for damage caused by my group or to clean the facility after use *

Statement(Required)

All information, to the best of my knowledge, provided on this form is truthful *

* Applicant must agree by checking all statements above.

CAPTCHA

Housing & Redevelopment Authority of Mora – Preliminary Apartment Application

Please return your application to the HRA of Mora
160 Valhalla Circle, Mora, MN 55051

Phone: (320) 679-4789 ~ Fax: (320) 679-5638

Employment Application

Personal Information

Education

References

First Previous Employer

Second Previous Employer

Third Previous Employer

Military Service

Maintenance Technician Supplemental Application Form

Disclaimer and Signature

Contact

Location

Hours

Site Map

Eastwood Life Enrichment Center
Facilty Rental Application

Rental Rates

The applicant is responsible for informing members of their group of their duties / responsibilities under policies

1.

2.

3.

4.

Housing & Redevelopment Authority of Mora – Preliminary Apartment Application

Contact Information

Household Information

Head of Household

Spouse Co-Head

Member 3

Member 4

Income Information

Other Information

Federal Data on Race and Ethnicity

Applicant Certification