Baldwin
715-684-3307

Clear Lake
715-263-2513

Cumberland
715-822-4541

Ellsworth
715-273-5500

Glenwood City
715-265-4660

Zumbrota
507-732-7329

Online Application

*Required Fields

General Information

*Name: *Home Phone Number: Cell Number:
*Current Address: *City: *State: *Zip:
Position Desired: Desired Employment Status: Full Time Part time No Preference
Availability (Check all that apply):

Sunday Hours:
Monday Hours:
Tuesday Hours:
Wednesday Hours:
Thursday Hours:
Friday Hours:
Saturday Hours:

Education

Name of High School: Did you graduate? No Yes
High School Address: City: State: Zip:
Extracurricular activities and offices held within these groups:


Name of College or Technical School:
Address of College or Technical School: City: State: Zip:
Did you graduate? No Yes What is degree in?
Any specialized training or skills?


Work History

Please list previous work history starting with the most recent using the following format for each in the space provided:

Company Name:
Company Phone Number:
Type of Industry:
Company Address:
Dates of Employment: (month/year - month/year)
Job Title:
Starting Pay Rate: $
Ending Pay Rate: $
Why did you leave?
Supervisor’s Name:
Supervisor’s Phone Number:
May we contact this person?


Explain any period of unemployment longer than 30 days:


General Questions

Store location preferred: Are you willing to relocate? No Yes Who referred you to us?
Briefly explain why you desire a position with this company and why you would make a valuable employee:


What date would you be able to start employment with Nilssen’s?

References

Please list three references (not former employers or relatives):
*Name: *Phone: Reference type: Personal Business
Occupation: How many years have you known this person?
May we contact this person? No Yes

*Name: *Phone: Reference type: Personal Business
Occupation: How many years have you known this person?
May we contact this person? No Yes

*Name: *Phone: Reference type: Personal Business
Occupation: How many years have you known this person?
May we contact this person? No Yes

*I verify that all of the information given on this application is true to the best of my knowledge.
*Signature (Please type your name): Date: 2/17/2019
By typing your name you are bound by all terms as such with a written signature.


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