If you are applying for a nursing position, please provide license number:
Hours Requested:
I have a valid driver's license:
I would be available to work in the Duluth area:
I would be available to work in or around Carlton County:
I would be available to work in or around Virginia:
I would be available to work in or around Two Harbors:
Previous DRCC Employee:
I Am Willing To Work Overnights:
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Education and Work History
Highest Completed Education Level:
Name of School:
Major:
Year Obtained:
GPA:
If you have been disciplined or discharged for a substantiated claim of abuse or neglect, please explain:
Name of Most Recent Employer:
Type of Business:
Address:
City:
State:
Zip Code:
Phone Number:
Starting Date:
Ending Date:
Job Title:
Starting Wage (per hour):
Ending Wage (per hour):
Name of Supervisor:
I allow DRCC to contact this employer to verify my work history:
If part time, how many hours:
Full Time:
Reason for Leaving:
Description of Duties:
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References
Who referred you to DRCC?:
Name of First Reference:
First Reference's Business or Profession:
First Reference's Phone Number:
Name of Second Reference:
Second Reference's Business or Profession:
Second Reference's Phone Number:
Please write a short statement describing why you desire employment with DRCC:
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Affirmative Action Form (Optional - Your Application Has Been Submitted)
I identify as Male:
I identify as Female:
I identify as Non-Binary (Transgender/Gender Non-Conforming or third gender):
I Choose Not to Self-Identify Sex/Gender:
I consider myself White :
I consider myself Black or African American:
I consider myself Hispanic or Latino:
I consider myself American Indian/Alaskan Native:
I consider myself Asian:
I consider myself Native Hawaiian or Other Pacific Islander:
I Choose Not to Self-Identify My Race:
I consider myself to be a disabled person.:
I am a Veteran :
I am a Vietnam Era Veteran.:
I am a Disabled Veteran.:
I am a Desert Storm Veteran.:
I am a Operation Iraqi Freedom Veteran.:
I am a Operation Enduring Freedom Veteran.:
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Completed!
Thank you!Your application will be processed and made available to either the specific program you identified or our general applicant pool.Our Program Directors will contact you directly to set up an interview.