To apply for a Government Job in the State of Montana download and submit this form you can also Apply Online at http://mt.gov/statejobs/statejobs.asp but you can also download the form below and submit it manually to the office.
State of Montana Government Job Application
Text Version of this Form
———————– Page 1———————–
PAGE 1
State Use OnlyState Of Montana Employment Application
An Equal Opportunity Employer
IMPORTANT: You are encouraged to apply online (http://mt.gov/statejobs/statejobs.asp); however, you may submit this
application. Please type or print in ink. You may respond to sections 4 through 7 on separate sheets of paper if you complete
all relevant blocks and follow the same format On each sheet include your name and the job title for which you are applying.
You must sign and date each application you submit. Late, incomplete, or unsigned applications will not be considered.Please read the job listing carefully to verify the following: (a) what attachments you are required to submit; (b) where to
submit your application; (c) the required special qualifications or licenses; and (d) the closing date for receipt of application.
Tailoring the application to the position is to your advantage.1. Name
Last First Middle
Mailing Address
Street or PO Box
City State Zip Code
Telephone Number ( ) ( ) ( )
Work Home Cell
Email address2. Provide the information below from the j ob listing:
Department
Division Job Location
Position Title Position Number
3. The information you provide on this application is subject to verification. Falsifications or misrepresentations may disqualify
you from consideration for employment with the State of Montana or, if hired, may be grounds for termination at a later date.Do you want to be informed before we contact your present employer? Yes No
With my signature below (typed or written), I certify that all information on this and all attached pages is true, correct and
complete to the best of my knowledge and contains no willful falsifications or misrepresentations. I authorize all former
employers to release job-related information they may have about me to the State of Montana or its agents and employees.
I release all persons or companies from any liability or responsibility for providing such information.SIGNATURE DATE SIGNED
PD-25 (Rev.04/09)
———————– Page 2———————–
PAGE 2
4. EDUCATION – High School Name:
High School Address:
Received Diploma? Yes No GED?
College, University and Other Schools Dates Degree/ Degree/ Major/ Credits
Name and Location Attended Certificate Certificate Minor Field Earned
Month/Year Received Date Indicate Qtr
or SemTraining Courses Dates Did you Total
Title/Description of Course
Name and Location Attended Complete? Hours
Month/Year5. List current Professional Licenses, Registrations, or Certifications (engineering, medical, CPA, etc.)
Licensing Agency Endorsement/Restriction Date
Name and Location Type of License (if applicable) Licensed6. List special skills such as word processing, operating a forklift, heavy equipment or computer programming. Include a list
of equipment that you know how to use. May list skills from volunteer work like Habitat for Humanity or from professional
organizations like Toastmasters.———————– Page 3———————–
PAGE 3
7. EXPERIENCE: List your work and volunteer experience. Emphasize the experience you have that is relevant to the
vacant position (refer to job listing ). Begin with your present or most recent experience. Include military service that
would help you qualify. List each promotion as a separate position. Use Additional Employment Experience forms (PD-
30) as necessary. You must complete this information even if you submit a resume.Name & Complete
Address of EmployerYour Job Title: Dates Employed / to /
Month Year Month Year
Type of Business:
Avg. Hrs. Per Week Time Employed: /
( ) Years / Months
Full-time Part-time Volunteer
Immediate Supervisor(s) Phone No.Describe your duties in detail (Maximum of 6000 characters, about 1000 words, or a page and a half) –
Reason for Leaving:
Name & Complete
Address of EmployerYour Job Title: Dates Employed / to /
Month Year Month Year
Type of Business:
Avg. Hrs. Per Week Time Employed: /
( ) Years / Months
Full-time Part-time Volunteer
Immediate Supervisor(s) Phone No.Describe your duties in detail (Maximum of 6000 characters, about 1000 words, or a page and a half) –
Reason for Leaving:
EXPERIENCE CONTINUED ON PAGE 4
———————– Page 4———————–
PAGE 4
7. EXPERIENCE Continued….Name & Complete
Address of EmployerYour Job Title: Dates Employed / to /
Month Year Month Year
Type of Business:
Avg. Hrs. Per Week Time Employed: /
( ) Years / Months
Full-time Part-time Volunteer
Immediate Supervisor(s) Phone No.Describe your duties in detail (Maximum of 6000 characters, about 1000 words, or a page and a half) –
Reason for Leaving:
Name & Complete
Address of EmployerYour Job Title: Dates Employed / to /
Month Year Month Year
Type of Business:
Avg. Hrs. Per Week Time Employed: /
( ) Years / Months
Full-time Part-time Volunteer
Immediate Supervisor(s) Phone No.Describe your duties in detail (Maximum of 6000 characters, about 1000 words, or a page and a half) –
Reason for Leaving:
———————– Page 5———————–
PAGE 5
APPLICANT SURVEYTitle VII of the U.S. Civil Rights Act requires the State of Montana to “make and keep records relevant to the determinations of
whether unlawful employment practices have been or are being committed.” The Montana Human Rights Act and state and
federal laws also require the state to track employment opportunities for veterans and persons with disabilities. The following
survey helps fulfill these requirements.This applicant survey will be separated from your application. The survey information will be kept confidential, used only for
computerized statistical reports and other lawful uses. Analysis of the information you and others provide will be used to
monitor recruitment and selection practices in state government.Because this sheet is separated from your application, please give us your name, address and phone number again. State
of Montana has a Human Resource System that automates recruitment information. To prevent duplicate records, please
answer the following questions. Thank you for your cooperation.Have you applied for a state government job in the past? Yes No
Are you a current or past state government employee? Yes No
9. Name
First Middle Last
Mailing Address City/State/ZipEmail Home Phone No. ( ) Other Phone Numbers (such as business,
cellular) – Indicate type of phone.Type Phone No. ( ) Type Phone No. ( )
Job Applied For: Department Job Title
Position No. Closing Date Location
10. REFERRAL SOURCE – How did you FIRST learn of this position?
Newspaper Ad State employment (current/former)
Newspaper Ad on Internet Tribal Government Referral
State of Montana Employment website Another Referral Organization (women/older work programs)
State Department/Agency website Tribal College
Job Service Office/website Career/Job Fair11. FEMALE MALE
12. RACE/ETHNIC IDENTIFICATION – PLEASE CHECK ALL THAT APPLY
Are you of Hispanic or Latino origin? Yes No (A person of Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture or origin, regardless of race.)SELECT ONE OR MORE OF THE FOLLOWING RACIAL CATEGORIES:
American Indian or Alaska Native (A person having origins in any of the original peoples of North or South America,
including Central America, and who maintains tribal affiliations or community attachment.)
Asian (A person having origin in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent
including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and
Vietnam.)
Black or African American (A person having origins in any of the black racial groups of Africa.)
Native Hawaiian or other Pacific Islander (A person having origins in the original peoples of Hawaii, Guam, Samoa,
or other Pacific Islands.)
White (A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.)13. DISABILITY STATUS – Person with a disability (non-veteran) Veteran with a disability
15. MILITARY STATUS – Please check the one box that best describes your military status.
No Military Service Active Duty National Guard Reserve Retired Military Former Service
(separated, not retired)Vietnam Era Veteran? Yes No
———————– Page 6———————–
State of Montana Employment and Benefit Information
Reasonable Accommodations –Montana state government is committed to providing reasonable
accommodations to applicants and employees with disabilities in accordance with federal and state laws.
Reasonable accommodations are available upon request to assist applicants and employees in any of the
following: equal opportunity in the in the employment process;
enable qualified individuals with disabilities to perform the essential functions of the job; and
enable employees with disabilities to enjoy equal benefits and privileges of employment.Applicants who need an accommodation to participate in the selection process should request the accommodation
as early as possible. The State of Montana will make every effort to respond promptly to a request for
accommodation. Click the Reasonable Accommodation and EEO link for more information.Equal Employment Opportunity – The State of Montana is an equal opportunity employer; the state does not
discriminate in employment based upon race, color, national origin, age, physical or mental disability, martial status,
religion, creed, sex, sexual orientation, or political beliefs, and implements and maintains an effective equal
employment opportunity program.State employees have the right to work in an environment free discrimination. The State of Montana prohibits
discrimination in hiring, firing, promotions, compensation, job assignments, and other terms, conditions, or
privileges of employment. The State of Montana may not retaliate or allow, condone, or encourage others to
retaliate against any applicant, employee, or past employee for opposing unlawful discriminatory practices, filing a
discrimination complaint, or testifying or participating in an other manner in a discrimination proceeding. Click the
Reasonable Accommodation and EEO link for more information.Employment Preference – Employment preference allows applicants to claim a preference under the Veterans’
Public Employment Preference Act or the Persons with Disabilities Public Employment Preference Act. Applying for
a preference is voluntary. All information related to a preference will be kept confidential and used only during the
hiring process. State agencies will have this information in a separate confidential selection file. An applicant
claiming employment preference must complete an Employment Preference Form, available at
http://wsd.dli.mt.gov/service/app.asp (scroll down to State of Montana Employment Application & Information).
You must also provide the appropriate documentation of eligibility with the application.Contact your local Job Service Workforce Center for details on veterans’ preference. Contact your local Montana
Vocational Rehabilitation Services Office, Department of Public Health and Human Services (DPHHS) for details on
obtaining persons with disabilities preference certification.Immigration Reform and Control Act – In accordance with the Immigration Reform and Control Act, the person
selected must produce within three days of hire, documentation that he or she is authorized to work in the United
States. Examples of such documentation include a birth certificate or social security card along with a driver’s
license or other picture I.D (United States Passport, Certificate of Naturalization, Permanent Resident Card, Alien
Registration Receipt Card [Green Card], or a Resident Alien Card).Montana Compliance with Military Selective Service Act – In accordance with the Montana Compliance with
Military Selective Service Act, men selected for state government employment must produce documentation
showing compliance with the federal Military Selective Service Act. Examples of this documentation include a
registration card issued by Selective Service, a letter from Selective Service showing a man was not required to
register, or information showing by a preponderance of evidence that a man’s failure to register with Selective
Service was not done knowingly or willfully.For other employment information, click on the following links:
Employment Process Details;
Salary and Benefits; and
State Government Recruitment Contacts.