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2. 
4. The City of Winona welcomes your application for employment. Please complete all of the application so we may give you full consideration. Additional information, which you believe qualifies you for the position you are applying for, may be attached to this application. Submission of an incomplete application disqualifies you from consideration for employment.
6. All information contained in or connected with this application will be used only in conjunction with your possible employment with the City of Winona.
8. City of Winona, 207 Lafayette Street, Winona, MN 55987

   Human Resources, 507-457-8234, hr@winonamn.gov

10. First Name*
11. Last Name*
13. Address*
15. City*
16. State*
17. Zip Code*
19. Phone Number*
21. Email Address*
23. Are you over the age of 18? *

    1. Yes
    2. No
25. Do you have a valid driver's license? *

    1. Yes
    2. No
27. Will you be able to provide documentation to establish your identity and authorization to work in the United States?*

    1. Yes

    1. No
29. Have you previously been employed or volunteered with the City of Winona?*

    1. Yes

    1. No
31. Position
33. Dates of employment
35. Previous Employment
37. Employer (Most Recent)
39. Position
41. Supervisor
43. Supervisor's Phone Number
45. Briefly describe your job duties
47. (Optional) Please upload your resume
49. Where did you hear about this position?*

    1. Social Media
    2. City of Winona Website
    3. College Job Board

    1. Radio
    2. Newspaper
    3. Word of Mouth
51. Date Available to Start*
    Date Available to Start
53. Do you have any officiating or coaching certifications?*

    1. Yes
    2. No
55. Upload Officiating or Coaching Certifications*
57. Please list your officiating and/or coaching certifications.*
59. Please describe any previous experience playing, coaching, or officiating sport(s).*
61. Do you have any experience working with children and/or older adults?*

    1. Yes
    2. No
63. Please describe your experience working with children and/or older adults.*
65. Availability *

    Please indicate any schedule conflicts that would impact your availability. Please include other work schedules, class schedules, or regular sports schedules. Please do not include vacations or day off requests. 

67. The Minnesota Government Data Practices Act (Minn. Stat. §§ 13.01 – 13.90) includes two sections affecting applicants seeking employment with the City of Winona. First, under “Rights of Subjects of Data” (Minn. Stat. § 13.04), when an applicant is asked to provide information about him/herself, the City must advise you of: • The purpose and intended use of the data; • Whether you may refuse or are legally required to supply the requested data; • Any known consequences arising from your supplying or refusing to supply the data; and • The identity of other persons or organizations authorized by State of Federal law to receive the data you provide. Second under “Personnel Data” (Minn. Stat. §13.43) the following data on you as an applicant for employment by a public agency is automatically public: • Your veteran’s status; • Your job history; • Your education and training; • Your relevant test scores; • Your rank on our eligibility list; and • Work availability.
69. As an applicant, your name is considered private until you are certified as eligible for appointment to a position or are considered by the appointing authority to be a finalist for a position in public employment. If you are hired, the following additional data about you will be considered public information: • Your name; • Your employee identification number (which is not your Social Security number); • Your actual gross salary, contract fees, salary range, and actual gross pension; • The value and nature of employer paid benefits; • The basis for and the amount of any added remuneration, including expense reimbursement, in addition to your salary; • You job title, bargaining unit (if applicable) and job description; • The dates of your first and last employment with us; • The status of any written complaints or charges against you while you work for the City of Winona, regardless whether or not they have resulted in disciplinary action, the final disposition of any disciplinary action and supporting documentation; • You work location and work telephone number; • Your education and training background; • Work-related continuing education; • Honors and awards you have received; • Payroll timesheets or other comparable data that are only used to account for your works time for payroll purposes: except to the extent that release of time sheet data would reveal employee’s reasons for the use of sick or other medical leave or other non-public data; • Your previous work experience; • The “complete” terms of any settlement agreement (including buyout agreements) except that the agreement must include the specific reasons if it involves the payment of more than $10,000 of public money; and • Your badge number. This data is private if the candidate is applying for or is hired for an undercover law enforcement position.
71. All data concerning you which is placed in your personnel file and which is not addressed in statute as public data (see above listing) is private data. This private data will be available to you and those members of city staff needing it to process city records. In addition, the following persons or organization are authorized by state and federal law to receive this data if they so request in certain circumstances: • The Bureau of Census; • Federal, State and County Auditors; • The State Department of Public Welfare; • The Department of Human Rights; • Federal Officials investigating compliance of Affirmative Action and Equal Employment Opportunities; • Labor organizations and the Bureau of Mediation Services; • Data may also be made available through court order.
73. With the exception of the optional data requested, the data you provide is needed to identify you and you assist in determining your suitability for the position for which you are applying.
75. NOTICE TO MINORS: Minors from whom private data or confidential data is collected have the right to request that parental access to the private data be denied.
77. If you have any questions regarding your rights as a subject of data, please contact the City of Winona Human Resources Department at 207 Lafayette Street, Winona, MN 55987. This information is subject to change consistent with subsequent amendments to the Minnesota Government Data Practices Act.
79. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
81. Electronic Signature*
82. Today's Date
    Today's Date

84. Thank you for your interest in working for the City of Winona. You will be contacted by Parks & Recreation Staff regarding next steps.

Leave This Blank:


86. 1. Receive an email copy of this form.
87. Email address

    This field is not part of the form submission.

88. Submit Submit and Print

* indicates a required field