Form Center

Do not include dates more than 10 years ago.

Check one below.

THE CITY OF ST. ANTHONY CONDUCTS CRIMINAL HISTORY BACKGROUND CHECKS ON ALL EMPLOYEES.

FOR SWORN POLICE POSITIONS, FELONY CONVICTIONS (AND CERTAIN OTHER CONVICTIONS MANDATED BY THE STATE LICENSING BOARD FOR POLICE) WILL AUTOMATICALLY DISQUALIFY YOU FROM FURTHER CONSIDERATION. FOR NON-POLICE POSITIONS, THE CITY WILL LOOK AT THE TYPE OF CONVICTION AND WHETHER IT IS DIRECTLY RELATED TO THE JOB FOR WHICH YOU ARE APPLYING.

CANDIDATES FOR POSITIONS WORKING WITH CHILDREN WILL NOT BE SELECTED IF THEY HAVE BEEN CONVICTED OF ANY CRIME LISTED IN THE CHILD PROTECTION WORKER ACT (MINNESOTA STATUTES 299C.61 & 62). GENERALLY THIS INCLUDES CHILD ABUSE CRIMES, MURDER, MANSLAUGHTER, FELONY LEVEL ASSAULT OR ANY CRIME COMMITTED AGAINST A MINOR, KIDNAPPING, ARSON, CRIMINAL SEXUAL CONDUCT, AND PROSTITUTION RELATED CRIMES.

BEFORE ANY APPLICANT (OTHER THAN APPLICANTS FOR POSITIONS WITHIN THE POLICE OR FIRE DEPARTMENT) IS REJECTED ON THE BASIS OF CRIMINAL CONVICTION, HE OR SHE WILL BE NOTIFIED IN WRITING AND WILL BE GIVEN ANY RIGHTS AFFORDED BY MINNESOTA STATUTES CHAPTER 364. THIS INCLUDES THE RIGHT TO SHOW EVIDENCE OF REHABILITATION.

THE MINNESOTA GOVERNMENT DATA PRACTICES ACT REQUIRES THAT YOU BE INFORMED OF THE PURPOSES AND INTENDED USES OF THE INFORMATION YOU PROVIDED TO THE CITY OF ST ANTHONY DURING THE APPLICATION PROCESS OR DURING EMPLOYMENT. ANY INFORMATION ABOUT YOURSELF THAT YOU PROVIDE WILL BE USED TO IDENTIFY YOU AS AN APPLICANT AND TO ASSESS YOUR QUALIFICATIONS FOR EMPLOYMENT WITH THE CITY. IF YOU WISH TO BE CONSIDERED FOR EMPLOYMENT, YOU ARE REQUIRED TO PROVIDE THE INFORMATION REQUESTED IN THE APPLICATION FOR EMPLOYMENT. IF YOU REFUSE TO SUPPLY INFORMATION REQUESTED BY THE CITY, IT MAY MEAN YOUR APPLICATION WILL NOT BE CONSIDERED.

YOU ARE HEREBY ADVISED THAT, UNDER MINNESOTA LAW, THE FOLLOWING INFORMATION GIVEN BY AN APPLICANT IS CONSIDERED TO BE PUBLIC: VETERAN STATUS, RELEVANT TEST SCORES, RANK ON OUR ELIGIBLE LIST; JOB HISTORY; EDUCATION AND TRAINING; WORK AVAILABILITY.

AS AN APPLICANT, YOUR NAME IS CONSIDERED PRIVATE UNTIL YOU ARE CERTIFIED AS ELIGIBLE FOR APPOINTMENT TO A POSITION OR WHEN APPLICANTS ARE CONSIDERED BY THE APPOINTING AUTHORITY TO BE FINALISTS FOR A POSITION WITH THE CITY OF ST ANTHONY. “FINALIST” MEANS AN INDIVIDUAL WHO IS SELECTED TO BE INTERVIEWED BY THE APPOINTING AUTHORITY PRIOR TO SELECTION.

THE DATA CONCERNING YOU, WHICH IS PLACED IN YOUR APPLICATION FOLDER OR IN YOUR PERSONNEL FILE AND WHICH IS NOT LISTED AS PUBLIC, IS PRIVATE. THIS PRIVATE DATA WILL BE SHARED WITH YOU AND THOSE MEMBERS OF THE CITY STAFF WHO NEED IT TO PROCESS THE APPLICATION, UPDATE YOUR PERSONNEL RECORD, EVALUATE YOUR WORK PERFORMANCE AND IF YOU ARE HANDICAPPED, PROVIDE THE NECESSARY ACCOMMODATIONS. IT MAY ALSO BE SHARED WITH THE FOLLOWING: PERSONS AUTHORIZED TO HAVE ACCESS TO THE INFORMATION UNDER STATE OR FEDERAL LAW; PERSONS AUTHORIZED BY COURT ORDER TO HAVE ACCESS TO THE INFORMATION; AND PERSONS TO WHOM YOU CONSENT IN WRITING TO HAVE ACCESS TO THE INFORMATION.

WITH THE EXCEPTION OF RACIAL AND ETHNIC DATA, THE DATA YOU GIVE US ABOUT YOURSELF IS NEEDED TO IDENTIFY YOU AND TO ASSIST DETERMINING YOUR SUITABILITY FOR THE POSITION FOR WHICH YOU ARE APPLYING. RACIAL AND ETHNIC DATA IS USED TO MONITOR PROTECTED CLASS EMPLOYMENT AND TO MEET FEDERAL, STATE, AND LOCAL REPORTING REQUIREMENTS. FURNISHING RACIAL AND ETHNIC DATA ABOUT YOURSELF, AS WELL AS YOUR SOCIAL SECURITY NUMBER, IS VOLUNTARY.

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION FOR EMPLOYMENT AS MAY BE NECESSARY IN ARRIVING AT AN EMPLOYMENT DECISION. I UNDERSTAND THAT THIS APPLICATION IS NOT, AND IS NOT INTENDED, TO BE A CONTRACT FOR EMPLOYMENT. IN THE EVENT OF EMPLOYMENT, I UNDERSTAND THAT FALSE OR MISLEADING INFORMATION GIVEN IN MY APPLICATION, OR INTERVIEW(S), MAY RESULT IN DISCHARGE. I UNDERSTAND ALSO, THAT I AM REQUIRED TO ABIDE BY ALL RULES AND REGULATIONS OF THE CITY.

I CERTIFY THAT ANSWERS HEREIN ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I CERTIFY THAT I HAVE READ THE “NOTICE TO APPLICATION” REGARDING THE MINNESOTA DATA PRACTICES ACT (MN STATUTES 1301-1390), AND I UNDERSTAND MY RIGHTS AS A SUBJECT OF DATE.

AS AN APPLICANT FOR A POSITION WITH THE CITY OF ST. ANTHONY VILLAGE, I CONSENT TO THE CITY OF ST. ANTHONY VILLAGE POLICE DEPARTMENT CONDUCTING A CRIMINAL HISTORY BACKGROUND INVESTIGATION ON ME. I UNDERSTAND THAT THE INFORMATION I PROVIDE IS CLASSIFIED AS PRIVATE. I CONSENT TO THE RELEASE OF THE INFORMATION I AM PROVIDING IN THIS BACKGROUND INVESTIGATION FORM AND ANY OTHER INFORMATION OBTAINED AS A RESULT OF THIS BACKGROUND INVESTIGATION, AS IS NECESSARY AND APPROPRIATE, TO THE CITY OF ST. ANTHONY VILLAGE.

Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.

I DECLARE THAT ANY AND ALL STAEMENTS IN THIS APPLICATION OR INFORMATION PROVIDED ARE TRUE AND COMPLETE AND HEREBY ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE INFORMATION CONTAINED HEREIN.

THE CITY OF ST. ANTHONY DOES NOT DISCRIMINATE ON THE BASIS OF RACE, COLOR, NATIONAL ORIGIN, SEX, RELIGION, AGE, SEXUAL ORIENTATION, FAMILIAL STATUS OR DISABILITY IN EMPLOYMENT OR THE PROVISION OF SERVICES.

THE CITY OF ST. ANTHONY DOES NOT DISCRIMINATE ON THE BASIS OF HANDICAPPED STATUS IN THE ADMISSION OR ACCESS TO OR TREATMENT OF OR EMPLOYMENT IN, ITS PROGRAMS OR ACTIVITIES. IT IS THE POLICY OF THE CITY OF ST. ANTHONY TO PROVIDE REASONABLE ACCOMMODATIONS TO KNOWN PHYSICAL AND MENTAL LIMITATIONS OF QUALIFIED HANDICAPPED APPLICANTS AND EMPLOYEES IN ORDER FOR TO PERFORM THE ESSENTIAL FUNCTIONS OF THE JOB IN QUESTION.

NOTE: COPY OF “MEMBER COPY 4” VETERAN’S DD214, OR OTHER DOCUMENTATION VERIFYING SERVICE, MUST BE ATTACHED

(Veteran is defined by Minnesota State § 197.447)

You must submit a PHOTOCOPY of your “Member Copy 4” of your DD214 or other documentation verifying service to substantiate the services information requested on the form. Claims not accompanied by proper documentation will not be processed. For assistance in obtaining a copy of your “member Copy 4” of your DD214, or other documentation verifying service, contact your County Veterans’ Service Office.

The City of St. Anthony operates under a point preference system, which awards points to qualified veterans to supplement their application. Ten (10) points are granted to non-disabled veterans on open competitive examinations; Fifteen (15) points are awarded if the veteran has a service connected compensable disability as certified by the U.S. Department of Veterans Affairs (USDVA).

To qualify for preference for a competitive exam, you must have earned a passing score and been separated under honorable conditions from any branch of the armed forces of the United States after having served on active duty for 181 consecutive days, or by reason of disability incurred while serving on active duty, or after having served the full period called or ordered for federal, active duty and be a United States citizen or resident alien. Veteran’s preference may be used by the surviving spouse of a deceased veteran, or have active military service certified under 38 U.S.C. § 106, and by the spouse of a disabled veteran who is unable to qualify because of the disability.

To qualify for preference on a promotional exam, a veteran must have earned a passing exam score and received a USDVA active duty service connected disability rating of 50% or more. For a promotional exam, a qualified disabled veteran is entitled to be granted five (5) points. Disabled veterans eligible for such preference may use the five points preference only for the first promotion after securing employment with the City of St. Anthony.

Claims must be made on the form below and submitted with your application by the application deadline of the position for which you are applying. If the “Member Copy 4” DD214, or other documentation verifying service, is submitted to our office separate from this sheet, please attach a note with it indicating the position for which you are applying and your present address.

“Member Copy 4” of DD214 or DD215, or other documentation verifying service, must be submitted to receive points.

“Member Copy 4” of DD214, or other documentation verifying service, and USDVA letter of a compensable disability rating decision must be submitted to receive points.

“Member Copy 4” of DD214 or DD215, or other documentation verifying service, and USDVA letter of a compensable service connected disability rating decision must be submitted to receive points.

"Member Copy 4” of DD214 or DD215, or other documentation verifying service, and USDVA letter of a compensable service connected disability rating decision must be submitted to receive points.

I hereby claim Veterans’ Preference points for this examination and swear/affirm that the information given is true, complete and correct to the best of my knowledge. I hereby acknowledge that I am responsible to obtain the required Veterans’ Preference verification documents and submit them to the City of St. Anthony by the required application deadline.

The information requested below will be used for statistical purposes only. It will enable us to evaluate our recruitment process in light of federal and state equal opportunity laws. Your cooperation is strictly voluntary. Your application will be reviewed whether or not you provide this information.

Thanks for your help!