Application Form

Connections is an equal employment opportunity employer and will not discriminate against any applicant or employee on any grounds protected under federal, state, or local law, including race, color, creed, religion, age, sex, sexual harassment, national origin, ancestry, marital status, handicap, disability related to pregnancy or childbirth, affectional or sexual preference, membership or activity in any local commission, or status regarding public assistance, membership or non-membership in any labor organization, or any other characteristic protected under federal, state or local law. None of the questions in this application are intended to elicit information regarding any protected characteristics, nor imply any limitations, preference, or discrimination based protected characteristics.

If you are hired by Connections, you will be employed on an at-will basis. As an at-will employee, you may terminate your employment at any time and for any reason. Similarly, if you are hired, Connections will have the right to terminate your employment at any time and for any reason.

You can fill in the form below and submit your information online or you can download a PDF version of our application (104.85 KB), print it out, fill it in and sign it, and mail it to:

Connections of Moorhead

810 4th Ave S, Suite 156
Moorhead, MN 56560

Application Form
  • Full Name:
  • Current Address:
  • City:
  • State:
  • Zip code:
  • Home phone:
  • Cell phone:
  • Other phone:
  • E-mail:
  • Preferred method of contact:
  • Position applied for:
  • Date of application:
  • Full-time:
  • Part-time:
  • Referral Source:
  • Please Identify Source:
  • If hired, can you furnish proof that you are 18 years of age, or older?
    Yes: No:


  • If no, please explain:
  • If hired, can you furnish proof that you are eligible to work in the U.S.?
    Yes: No:


  • If no, please explain:
  • Have you been convicted of abuse?
    Yes: No:


  • If yes, please explain and list country/state:
  • Have you been convicted of a felony in the last seven years?
    Yes: No:


  • If yes, please explain:
  • Have you applied for or worked for Connections before?
    Yes: No:


  • If yes, when?:
  • Are you currently certified in CPR?
    Yes: No:

  • First Aid?
    Yes: No:
  • Date you can start:
  • Desired Wage or Salary:
  • Days Available (e.g. Mon - Fri):



  • Shifts Available:
  • Education Level:
  • Major (if college graduate):
  • Have you ever been disciplined or discharged by an employer?
    Yes: No:


  • If yes, please explain:
Work History

List employers during the last five years, with present or last employer first, including military experience. Please explain any gaps in employment.

  • 1.) Employer Name:
  • City:
  • State:
  • Position:
  • Duties:
  • Supervisor's Name/Title:
  • Phone Number:
  • Full-time or Part-time:
  • Dates of Employment:
  • Final Pay Rate:
  • Reason for Leaving:
  • 2.) Employer Name:
  • City:
  • State:
  • Position:
  • Duties:
  • Supervisor's Name/Title:
  • Phone Number:
  • Full-time or Part-time:
  • Dates of Employment:
  • Final Pay Rate:
  • Reason for Leaving:
  • 3.) Employer Name:
  • City:
  • State:
  • Position:
  • Duties:
  • Supervisor's Name/Title:
  • Phone Number:
  • Full-time or Part-time:
  • Dates of Employment:
  • Final Pay Rate:
  • Reason for Leaving:
Form Actions

Serving people with disabilities throughout the community

Connections of Moorhead
810 4th Ave S, Suite 156
Moorhead, MN 56560

Phone: (218) 233-8657
Fax: (218) 236-5983