Application for Employment - Wisconsin

OSER-DMRS-38 (rev. 06-10)
Wis. Stats. 230.16 1 of 2
STATE OF WISCONSIN
APPLICATION FOR STATE EMPLOYMENT
1. * Job Information
Job Announcement Title (Complete an application for each job.) Job Announcement Code(s) (seven digits)
____ ____ - ____ ____ __ __ ____ ____
____ ____ - ____ ____ __ __ ____ ____
Score Reuse: Some exams allow applicants to reuse their exam scores. See page 1 of t he instructions to learn more about score reuse.
2. Personal Information
* Last Name: * First Name: Middle Initial:
* Last Four Digits of Social Security Number:
____ ____ ____ ____
*Month of Birth (MM):
____ ____
*Day of Birth (DD):
____ ____
Year of Birth (YYYY)
(optional) __ __ __ __
* Mailing Address 1:
Mailing Address 2: *Mother’s Maiden Name: (last name only)
* City: * State: * Zip Code: * Country:
E-Mail Address:
Daytime Phone Number: Evening Phone Number:
Other Phone Number (e.g., cell): Fax Number:
3. * Are you currently legally authorized to work in the United States? Yes No
4. * Are you a Wiscon sin resident? Yes No
5. * Work Hours (Check all that you will accept.)
Full Time (40 hrs/week)
Part Time
(less than 40 hrs/w eek)
Seasonal
(minimum of 600 ho urs per year but less
than 1,828 hours per year.)
Evening 2
nd
Shift (3pm to 11 pm or similar hours)
Evening 3
rd
Shift (11pm to 7am or similar hours)
6. * Counties Where You Will Accept Employment (PLEASE NOTE THAT COUNTY CODES HAVE CHANGED.)
County Code(s): __ __ | __ __ | __ __ | __ __ | __ __ | __ __ | __ __ | __ __ | __ __ | __ __ | __ __
Administrative Use Only
* Indicates mandator
y
fields
Application continues on next page
Note: We will only consider you for jobs in the locations you indicate below. You must identify at least one county for us to
process your applicatio n. Enter 2-digit County Code(s) below using the list provided on page 3 of the instructions.
Page 5/6
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