Application for Employment - Wisconsin

OSER-DMRS-38 (rev. 06-10)
Wis. Stats. 230.16 2 of 2
Gender and race information are used for equal employmen t opportunity/affirmative action purposes only.
7. Gender 8. Race / Ethnicity
Female Male
9. Education Level
10. How did you hear about this job?
1. Office of State Employment Relations Internet:
2. Job Service/Job Center 9. Wisc.Jobs
3. State Agency/UW Cam pus 10. JobCenterOfWisconsin.com (JobNet)
4. Wisc.Jobs Bulletin 11. State Agency/UW Campus Website
5. Referred by Current State Employee
6. Referred by Friend or F amily
7. Job Fair 12. Other:______________ ______________
8. Newspaper Please list other source
11. Active Duty Military
12. * Certification Statement
By signing below, I certify that the information I have provided in this application is true to the best of my knowledge and
I understand that I may be required to verify the information before being appointed. I understand that any false,
misleading, or missing information may disqualify me from employment consideration.
* Signature:_________________________________ ______________________ ____ Date: __ __ / __ __ / __ __ __ __
(Check only one.)
1. Black (not Hispanic)
2. Asian or Pacific
Islander
3. American Indian or Alaskan
Native
4.
Hispanic
5. White (not Hispanic)
(Check highest level completed.)
1. Did not co mplete high school/GED
2. Completed GED/HSED
3. Graduated from high school
4. Some college, no degree
5. One-ye ar vocational diploma
6.
Two-year asso ciate degree
7. Bachelor's degre e
8. Some graduate degree courses
9. Grad uate college degre e
We will test active duty military members stationed out of state who are unable to test at a regularly scheduled exam center. We
will test only at approved U.S. military installations and only if the exam is administered by a Test Control Officer or equivalent
person. Please provide the following information for the person who has agreed to administer the exam. A fee may be charged
for this service.
Test Control Officer: Last Name:_______________________________ First Name:__________________________ M.I.:____
Title:___________ ________________________ _______ __ Agency:_____________ _______ ________________________ ___
Complete Mailing Addr ess:________________________ _______ ________________________ _______ ____________ ________
City:___ ________ ____________________ State:______ _ Zip:_______________ ___ Phone:__________________ ________
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