Employment Application with Disclosure of Use of Consumer Reports for Employment Purposes - Minnesota Counties Intergovernmental Trust

All applicants for jobs with MCIT must complete the MCIT Employment Application. MCIT prefers to have the employment application completed and submitted online (see below). Applicants can request an alternative format by contacting MCIT Director of Internal Services at frontdesk@mcit.org or 1.866.547.6516.

MCIT Employment Application with Disclosure of Use of Consumer Reports for Employment Purposes

Step 1 of 4

APPLICATION INSTRUCTIONS
1. Enter data in form fields. Those fields with a red asterisk (*) are required to be able to complete and submit the application.
2. When you are done entering information in the fields for each page, click "next." You must complete and submit the application in one session. You cannot save and come back to finish it later.
3. On the last page, you may upload supporting documents, such as a cover letter, resume, license information, etc.
4. After you click "submit," you will see a confirmation notice on the screen that the form has been successfully submitted to MCIT. If you do not see this confirmation notice, the application was not submitted. You may need to go back and enter information into required fields.
5. You may request a copy of the information you submit through this online form by contacting Pam Ihns at 866.547.6516, ext. 6421 or pihns@mcit.org.
6. If you have questions about the application process, please contact Pam Ihns at 866.547.6516 or pihns@mcit.org.
7. MCIT operates under a point preference system that awards points to qualified veterans to supplement their application. To claim Veterans Preference, applicants must complete the Veterans Preference Claim Form, which is separate from the Employment Application.
If you have any special needs that may necessitate accommodations in the application or interview process, please contact the Pam Ihns at 651.209.6400 or toll-free at 866.547.6516 to make a request.
I. EQUAL EMPLOYMENT OPPORTUNITY
It is the policy of Minnesota Counties Intergovernmental Trust to provide equal employment opportunity for all, without discrimination on the basis of race, color, creed, religion, national origin, sex, marital status, status with regard to public assistance, familial status, disability, sexual orientation or age.
II. DATA PRIVACY NOTICE
The information requested in this application process is intended to be used by Minnesota Counties Intergovernmental Trust in determining suitability for employment for the position, which you are currently seeking or may seek in the future. If hired, the information may later be used for consideration for other positions, verification of employment history or disciplinary action in the event that the information provided is not truthful. You are not legally required to provide any of the information requested in this form or as part of the application process at this time. However, failure to provide complete, accurate information may result in Minnesota Counties Intergovernmental Trust being unable or unwilling to offer employment to you. With respect to any special accommodations necessary for completing your application or the interview process, Minnesota Counties Intergovernmental Trust may be unable to provide the necessary accommodations if you do not provide this information.

The information you provide in this application process that is classified as private data under the Minnesota Government Data Practices Act (MGDPA) will not be released outside Minnesota Counties Intergovernmental Trust without your consent except as necessary for tax purposes or as otherwise required by state or federal law or court order. Information that is classified as public data will be released pursuant to the terms of the MGDPA.
Equal Employment Opportunity and Data Privacy Acknowledgement*
- I acknowledge receipt of the Equal Employment Opportunity and Data Privacy notices.
III. PERSONAL DATA
Name*
First Middle Last Suffix
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
This is required to receive e-mail confirmation of application submission.
Enter Email Confirm Email
Are you either a U.S. citizen or legally eligible to hold employment in the United States?*
- Yes
- No
List any other names under which you have been employed or under which your employment or educational records may be found. If none, enter "none":*
IV. POSITION DESIRED
Title of Position for Which You Are Applying*
Date Available to Begin Employment
MM slash DD slash YYYY
Desired Wage/Salary

V. WORK/VOLUNTEER EXPERIENCE
List all work and volunteer experience within the last 10 years regardless of its relevance to this position, and any additional relevant prior work or volunteer experience. List most recent first. Upload a file with additional information if necessary. You can do this on the last page of the online application.
Employer 1 Name
Employer 1 Address
City State / Province / Region Country
Employer 1: Job Title
Employer 1: Job Duties
Employer 1: Dates of Employment/Experience
Employer 1: Reasons for Leaving
Employer 2 Name
Employer 2 Address
City State / Province / Region Country
Employer 2: Job Title
Employer 2: Job Duties
Employer 2: Dates of Employment/Experience
Employer 2: Reasons for Leaving
Empoyer 3 Name
Employer 3 Address
City State / Province / Region Country
Employer 3: Job Title
Employer 3: Job Duties
Employer 3: Dates of Employment/Experience
Employer 3: Reasons for Leaving
Employer 4 Name
Employer 4 Address
City State / Province / Region Country
Employer 4: Job Title
Employer 4: Job Duties
Employer 4: Dates of Employment/Experience
Employer 4: Reasons for Leaving
Employer 5 Name
Employer 5 Address
City State / Province / Region Country
Employer 5 Job Title
Employer 5: Job Duties
Employer 5: Dates of Employment/Experience
Employer 5: Reasons for Leaving
VI. LICENSURE
List current licenses, registrations or certificates relevant to the position for which you are applying. Include license type, issued by and expiration information for each license. If requested, all applicable licenses or certificates must be received by Minnesota Counties Intergovernmental Trust prior to employment commencing. If hired, you remain responsible for ensuring that all applicable licenses remain in effect.

VII. EDUCATION
Have you received a high school diploma or high school equivalent diploma (GED)?*
- Yes
- No
High School Attended and Location (if GED, list institution issuing diploma)*
List college, university, technical, business, trade, vocational or other schools. LIst most recent first. Upload a document listing additional schools if necessary.
School 1 Name
School 1 Address
City State / Province / Region Country
School 1: Degree/Diploma Received
School 1: Course of Study
School 1: Number of Years Attended
School 2 Name
School 2 Address
City State / Province / Region Country
School 2: Degree/Diploma Received
School 2: Course of Study
School 2: Number of Years Attended
School 3 Name
School 3 Address
City State / Province / Region Country
School 3: Degree/Diploma Received
School 3: Course of Study
School 3: Number of Years Attended
List/Describe Any Other Training and/or Experience Relevant to the Position for Which You Are Applying

VIII. REFERENCES*
Minnesota Counties Intergovernmental Trust may ask for references if you become a finalist for the position you seek. Your references should be people who are in a position to discuss your qualifications for the position. MCIT reserves the right to contact all prior employers, educational institutions or institutions where you have volunteered in addition to references listed below.
- I understand that I may be required to provide professional references to MCIT later.
IX. CRIMINAL BACKGROUND INFORMATION*
Minnesota Counties Intergovernmental Trust may request information regarding criminal history in the event that you become a finalist for the position for which you are applying. For certain positions, criminal background information may be requested during the application stage. Further, Minnesota Counties Intergovernmental Trust may conduct a criminal background check on individuals upon making a contingent job offer. If a criminal background check will be conducted, no offer of employment shall become final until the results of the criminal background check from the Bureau of Criminal Apprehension (BCA) or other agency are received, the contents of the criminal background check are acceptable to Minnesota Counties Intergovernmental Trust, and formal approval is given by the appointing authority. You may request a copy of the results of any criminal background check obtained and may have the right to request additional information on the nature of the report.
- I have read the Criminal Background Information notice.
X. VETERANS STATUS*
If you are an honorably discharged veteran of the armed forces of the United States or the spouse of a disabled or deceased veteran and wish to claim Veterans Preference, complete the Veterans Preference Claim Form and supply proof of your eligibility to claim Veterans Preference points as set forth in the claim form.
- I have read the Veterans Status notice.
XI. PRIOR EMPLOYMENT
Have you ever been discharged or forced to resign from prior employment, other than in relation to a human rights charge or lawsuit in which you were the claimant/plaintiff?*
- Yes
- No
If so, Identify the employer and describe the circumstances
XII. UPLOAD RESUME, OTHER SUPPORTING DOCUMENT FILES
Please upload your cover letter, resume and any other supporting documents, such as additional work experience and school information not included on this online application form.
Drop files here or

Accepted file types: pdf, doc, txt, xls, docx, xlsx, Max. file size: 2 GB, Max. files: 10.
How did you learn about this employment opportunity?
Disclosure of Use of Consumer Reports for Employment Purposes
Minnesota Counties Intergovernmental Trust (MCIT) may engage a consumer reporting agency to conduct an employment background investigation for this position.

The employment background investigation may include but is not limited to information regarding verification of names, confirmation of date of birth, Social Security verification, address history, criminal records, civil litigation, tax liens and judgments, bankruptcy, employment and education verification, or other background checks. Credit history will be requested only in accordance with applicable law. Report(s) generated may include personal characteristics or mode of living. Information may be obtained from public and private records.

A separate disclosure and consent form authorizing a background investigation from a consumer reporting agency will be provided to the successful candidate in conjunction with a conditional job offer.

You have the right to promptly receive and inspect a copy of any consumer report, consumer investigative report or consumer credit report requested on you by MCIT from a consumer reporting agency at no charge. You may have the right to request additional information on the nature and scope of the report from the consumer reporting agency.
- Check here to receive a copy of your consumer report where applicable.
By clicking "submit," I confirm that I have received the above disclosure.
Date Submitted*
MM slash DD slash YYYY
XII. CERTIFICATION, ACKNOWLEDGMENT AND RELEASE*
I certify that the information I have given on this application, including in any submitted materials, is true and correct to the best of my knowledge. I understand that any false or misleading information provided, or any omission or concealment of facts, will disqualify me from consideration for employment, and constitutes grounds for my immediate dismissal should I be employed by Minnesota Counties Intergovernmental Trust.

I understand, acknowledge and agree that no offer of employment is valid or binding until formal approval by the appointing authority and that until such approval, Minnesota Counties Intergovernmental Trust shall not be liable for any reliance on any oral or informal written offers of employment made to me.

In connection with this application, I hereby authorize any and all former employers, organizations where I have volunteered ("volunteer organizations") and references or any agent of such a former employer or volunteer organization, to release to Minnesota Counties Intergovernmental Trust and its agents any and all information regarding my job performance and fitness/qualifications to perform the position I am presently seeking and any other employment or related information, both public and private, in their possession. I understand that Minnesota Counties Intergovernmental Trust will use this information to determine my fitness/qualifications for the position I am seeking. This authorization expires one year from the date of my signature below.

I hereby release Minnesota Counties Intergovernmental Trust and all former employers, volunteer organizations and references and any and all agents acting on behalf of said Minnesota Counties Intergovernmental Trust, former employers, volunteer organizations or references, for any and all liability of whatever nature by reason of requesting or providing such information.
- I Agree
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