City of Waconia, 201 South Vine Street, Waconia, MN 55387
TENNESSEN WARNING
It is the City of Waconia’s responsibility to inform potential employees of their privacy rights. Please
carefully read the Tennessen Warning provided below. Your signature indicates that you have received information regarding your rights as they
pertain to the Minnesota Government Data Practices Act.
In accordance with the Minnesota Government Data Practices Act, the City of Waconia is
required to inform you of your rights as they relate to the private information collected from you. Private
data is information that is available to you, but not to the public; the personal information we collect
about you is private. Minnesota Statutes 13.04 and 13.43 are two sections that govern what affects you
as an applicant for employment at the City of Waconia. Data collected is considered private except for
the following:
- Veteran status
- Relevant test scores
- Job history
- Education and training
- Work availability
Your name is considered to be private information; however, if you are selected to be interviewed
as a finalist, your name becomes public information.
The data supplied by you may be used for such other purposes as may be determined to be necessary
in the administration of personnel policies, rules, and regulations of the City of Waconia.
Furnishing social security numbers is voluntary for applicants to the City of Waconia, but refusal to
supply other requested information would mean that your application for employment might not be
considered.
Private data is available only to you, to appropriate city employees, and others as provided by state and
federal laws who have a bona fide need for the data. Public data is available to anyone requesting it
and consists of all data furnished in the application for employment that is not designated in this notice
as private data.
The information you give about yourself is needed to identify you and to assist the City of Waconia in
determining your suitability for the position for which you are applying.
I have read and understand the information given above regarding the Minnesota Data
Practices Act.
EMPLOYMENT APPLICATION
The City of Waconia does not discriminate on the basis of disability status in the admission or access to, or treatment or
employment in, its programs or activities. It is the policy of the City of Waconia to provide reasonable accommodations to the
known physical and mental limitations of qualified disabled applicants and employees in order for them to perform the essential
functions of the job in question.
THE CITY OF WACONIA IS AN EQUAL OPPORTUNITY EMPLOYER
INSTRUCTIONS:
If you need help to fill out this application form or for any phase of the employment process, please notify the
person that gave you this form and every effort will be made to accommodate your needs in a reasonable
amount of time
- Please read "APPLICANT NOTE"
- Complete all pages of this form.
- If more space is needed to complete any question, use comments section
- Print clearly; incomplete or illegible applications will not be processed.
APPLICANT NOTE:
This application form is intended for use in evaluating your qualifications for employment. This is not an employment
contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the
interview and on this form are grounds for terminating the application process or, if discovered after employment,
terminating employment. All qualified applicants will receive consideration without discrimination because of sex, marital
status, race, color, age, creed, religion, national origin or the presence of disabilities, sexual orientation, status with
regards to public assistance, or any other characteristic protected by law. The City conducts criminal history background
checks for all positions. A conviction of any kind
will not necessarily bar an applicant from employment, each case is evaluated on individual merit and type of work
sought. Additional testing of job-related skills, medical testing or drug testing may be required prior to
employment. Depending on City policy and the needs of the job, you may be required to complete a medical history form and
may be required to be examined by a medical professional designated by the City. This application applies only to the
position specified.