*Last name, first, middle *Date

*Street Address Home Phone

* City, State, Zip Other Phone

* Position Desired Social Security

Email Address Pay Expected

Do you have a list of references that you will provide to us? Yes No

Are you available for full-time work? Yes No If not, what hours can you work?

Are you legally eligible for employment in the United States? Yes No

Will you work overtime if asked? Yes No

When will you be available to begin work?

Have you ever been bonded? Yes No

If YES, with what employers?

Are you covered under a non-compete or similar agreement with a former employer? Yes No
If YES, describe in full

Are you willing to enter into a non-compete agreement? Yes No

Are you willing to grant us permission to obtain a consumer credit report? Yes No

Are you willing to grant us permission to obtain an investigative background report? Yes No

As a condition of employment, you would be required to complete an Independence Statement. Do you have any knowledge of independence issues with any clients of John A. Knutson Co., PLLP? Yes No
If YES, describe in full:

Do you currently have a valid Minnesota drivers license? Yes No

If NO, do you have a valid drivers license from another state? Yes No If YES, what state?

Do you currently have comprehensive automobile insurance coverage? Yes No

If you are applying for an accounting position, have you sat for the CPA exam? Yes No

If YES, have you passed or conditioned on any parts of the exam? Yes No
Parts passed, if any:

If you have not completed the entire exam, are you taking part in any review courses? Yes No N/A
If YES, what course(s)?

If you are a CPA, have you properly filed all Federal and State income tax returns? Yes No

Company #1

Company #2

Company #3

Company #4

Membership in professional and civic organizations, special accomplishments, awards or any other information you wish to include.
(Exclude those which may disclose your race, color, religion, age or national group).

Please read and understand this statement before signing your application:

The information I have provided in this Application for Employment is true, correct and complete. False, incomplete or misrepresented information of any kind, will be sufficient cause for my application to be rejected or, if discovered after I am employed, cause for immediate termination of my employment.

I authorize the employer to contact and obtain information about me from previous employers, educational institutions and "references" I provided, and any other party necessary to verify the accuracy of information I disclosed in this application. I waive the rights and claims I may otherwise have against the employer or its representatives, for seeking, and using information to evaluate my employment request and all other persons, corporations or organizations who provide information for this purpose.

This application will expire in 60 days. After that date, unless otherwise notified, I understand that my status as an applicant will end. I may re-apply for employment in the future by completing a new application.

This application is not an employment agreement. If I accept an offer of employment, I understand the employer may terminate my employment at any time, with or without cause and without prior notice, unless required by law. I understand that no one, other than a Partner of John A. Knutson Co., PLLP, has authority to enter into any employment agreement with terms contrary to the foregoing and then only in writing signed by such partner.

I fully understand and accept all terms and conditions in the above statement.