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 consider myself White (not of Hispanic origin). This pertains to all persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.:
I consider myself Black (not of Hispanic origin). This pertains to all persons having origins in any of the Black racial groups of Africa.:
I consider myself Hispanic. This pertains to all persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.:
I consider myself an American Indian or Alaskan Native. This pertains to all persons having origins in any of the original peoples of North America and who maintain cultural identification through tribal affiliation or community recognition.:
I consider myself Asian or a Pacific Islander. This pertains to all persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands, and Samoa.:
I consider myself to be a disabled person.:
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.:
I Choose Not to Self-Identify:
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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.
