Clean Water Action Alliance of Minnesota

Employment Application

Note: * Required field

* Name:

Current Address

* Street:

* City:

* State:

* Zip:

Permanent Address

Street:

City:

State:

Zip:

* E-mail:

* Phone:

Alt. Phone:

* For what position are you applying?

How did you find out about this job?

What are the most important factors in choosing a job? Rank from 1-4, (1 being highest):
Career Opportunities:
Working for something you believe in:
Salary:
Your work environment:
Other (explain):


Educational History

High School:

Location:

Year Graduated:

College:

Location:

Major:

Year Graduated:

Post Graduate/Other:

Location:

Major:

Year Graduated:


Employment History

Please note: Please enter n/a for any boxes for which you do not have information.

Job 1

* Employer:

* Address:

* Position:

* Supervisor:

* Phone number:

* Period Employed:
to
* Reason for leaving:

Job2

* Employer:

* Address:

* Position:

* Supervisor:

* Phone number:

* Period Employed:
to
* Reason for leaving:


Volunteer Experience

Political, community, or environmentally oriented:


Health Information

The job for which you are applying involves a substantial amount of public contact to present various issues. Do you have any health conditions, requirements, or physical handicaps that would effect your ability to perform this function? If so, please provide details:


Criminal Record

* Have you ever been convicted of a crime? Yes No

If so, please specify for each conviction:
The approximate date:

The jurisdiction (city and state):

The crime of which you are convicted:

Any further information or explanation you would like to provide concerning the circumstances of your arrest and conviction.


Professional References (Other than friends and relatives)
Reference 1:

* Name:

* Organization:

* Position:

* Phone number:

Reference 2:

* Name:

* Organization:

* Position:

* Phone number:

* I certify the truth and accuracy of all the information in this application, any attachments to the application and any resume I have submitted. I understand that providing false or misleading information in connection with this application is grounds for discharge.

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Offices

Contact an office near you!

California
111 New Montgomery St. # 600
San Francisco, CA 94105
(415) 369-9160
(415) 369-9180 Fax
cwasf@cleanwater.org

Connecticut
645 Farmington Ave 3rd Floor
Hartford, CT 06105
860-232-6232
860-232-6334 Fax
hartcwa@cleanwater.org

District of Columbia
4455 Connecticut Ave NW, A300
Washington, DC 20008-2328
(202) 895-0420
(202) 895-0438 Fax
dcjobs@cleanwater.org

Florida
141 NW 20th St. Suite B-21
Boca Raton, FL 33431
(561) 417-9995
(561) 417-9395 Fax
tbrock@cleanwater.org

Florida
7628 N. 56th St, Suite 16
Tampa, FL 33617
(813) 980-1221
(813) 980-1212 Fax
jpalermo@cleanwater.org

Maryland
711 West 40th St, Suite 209
Baltimore, MD 21211
(410) 235-8808
(410) 235-8816 Fax
baltcwa@cleanwater.org

Massachusetts
262 Washington, Suite 301
Boston, MA 02108
(617) 654-8284
(617) 338-6449 Fax
bostonjobs@cleanwater.org

Massachusetts
160 Main St. Suite 6
Northhampton, MA 01060
(413) 584-9830 
(413) 586-7180 Fax
nohocwa@cleanwater.org

Michigan
205 1/2 North Main St.
Ann Arbor, MI 48104
(734) 222-6347
(734) 222-6473 Fax
annarbor@cleanwater.org

Michigan
38875 Harper Ave.
Clinton Township, MI 48036
(586) 783-3277
(586) 783-4033 Fax
metrodetroit@cleanwater.org

Michigan
1200 Michigan Ave.
East Lansing, MI 48823
(517) 203-0754 
(517) 203-0760 Fax
elansingcwa@cleanwater.org

Minnesota
308 East Hennepin Ave.
Minneapolis, MN 55414
(612) 623-3666
(612) 623-3354 Fax
mncwa@cleanwater.org

New Hampshire
163 Court St.
Portsmouth, NH 03801
(603) 430-9565
(603) 430-9708 Fax
portcwa@cleanwater.org

New Jersey
1002 Ocean Ave.
Belmar, NJ 07719
(732) 280-8988
(732) 280-0371 Fax
njcwa@cleanwater.org

New Jersey
559 Bloomfield Ave.
Montclair, NJ 07042
(973) 744-3005
(973) 744-3069 Fax
ebenson@cleanwater.org

North Dakota
118 Broadway - Suite 314
Fargo, ND 58102
(701) 235-5431
(701) 235-1769 Fax
ndcwa@cleanwater.org

Pennsylvania
1124 Tilghman St.
Allentown, PA 18102
(610) 434-9223
(610) 434-5790 Fax
allentowncwa@cleanwater.org

Pennsylvania
100 N. 17th Street, 9th Floor
Philadelphia, PA 19103
(215) 640-8800
(215) 640-0930 Fax
philly@cleanwater.org

Pennsylvania
100 5th Ave, Suite 1108
Pittsburgh, PA 15222
(412) 765-3053
(412) 765-1737
pittcwa@cleanwater.org

Rhode Island
741 Westminster St.
Providence, RI 02903
(401) 331-6972
(401) 331-7072 Fax
provcwa@cleanwater.org

South Dakota
231 So. Phillips Ave. #200
Sioux Falls, SD 57104
(605) 978-9196
(605) 978-9197 Fax
sdcwa@cleanwater.org

Texas
715 West 23rd St. Suite R
Austin, TX 78705
(512) 474-0605
(512) 474-7024 Fax
txcwa@cleanwater.org

Virginia
4455 Connecticut Ave NW, A300
Washington, DC 20008-2328
(202) 895-0420
(202) 895-0438 Fax
dcjobs@cleanwater.org

Wisconsin
505 King St, Suite 157
LaCrosse, WI 54601
(608) 782-2012
(608) 796-2180 Fax