Metro Urology

*required

PERSONAL INFORMATION

May we contact you during the day?*
 yes no

,

POSITION INFORMATION

Are you at least 18 years of age?*
 yes no

Have you ever been employed here before?*
 yes no

If yes, please provide approximate dates of previous employment

Can you provide documentation to verify your identity and legal authority to work in the United States?*
 yes no

EDUCATIONAL BACKGROUND

Did you Graduate?
 yes no

Did you Graduate?
 yes no

Did you Graduate?
 yes no

Did you Graduate?
 yes no

Did you Graduate?*
 yes no

U.S. MILITARY SERVICE

Duties

MEMBERSHIP IN PROFESSIONAL OR CIVIC ORGANIZATIONS

You are not required to list activities that may reveal your race, age, religion, sex, national origin, marital status, sexual orientation, disability or any other protected status.

EMPLOYMENT EXPERIENCE

List most recent experience first. Please indicate the name you used during each employment if different from your present name.

May we contact them?
 yes no

May we contact them?
 yes no

May we contact them?
 yes no

May we contact them?
 yes no

ADDITIONAL INFORMATION

Have you ever been convicted of or pled guilty or no contest to a violation of the law other than a minor traffic violation?*
 yes no

If YES, please explain

*Answering “yes” will not necessarily disqualify you from employment

PERSONAL REFERENCES

How did you find about about this poisition?Star TribuneSt. Paul Pioneer PressMUS Staff MemberSearch/Placement FirmEmployment AgencyInternetFriend/RelativeOther

IMPORTANT – READ BEFORE SIGNING

Metro Urology is an equal opportunity employer and complies with all laws protecting discrimination of employees on the basis of sex, race, color, religion, creed, national origin, age, sexual orientation, marital status, disability, status with regard to public assistance and any other protected class status.

I certify that all of the information I provided Metro Urology in this application and during the hiring process is true and complete. I understand and acknowledge that any false, misleading, or incomplete information in this application or during the hiring process may result in rejection of my application or, if I have been hired, immediate termination of employment.

I authorize Metro Urology to investigate the information contained in this application and release it and its employees and agents from any and all liability for seeking information and opinions on me. I authorize all former employers, educational institutions, entities, and persons to release information concerning me and hereby release them from all liability for issuing such information. I hereby waive any privilege I have to such information. I also authorize Metro Urology to give references and provide information about me in response to inquiries if hired.

I understand and agree that nothing contained in this employment application or in the granting of an interview, and no policies, procedures, or handbooks of Metro Urology that I might receive if I am hired, are intended to create an employment contract between Metro Urology and me for either employment or for the providing of any benefit. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon Metro Urology unless made by the Executive Director of Metro Urology in a formal written agreement signed by both of us. If an employment relationship is established, I understand that I have the right to terminate my employment at any time for any reason or no reason, with or without cause, and with or without prior notice, and that Metro Urology has the same right.



Please initial that you fully understand and agree to these terms before uploading and submitting your resume*:

Attach your resume*

*required