Fax Us Your Rule 25 Referral: (320) 963-6279 or Call (651) 338-3317

Employment Application

Please email your resume to Tina at: tclark@mlrecovery.org, or fax to: (320) 963-6279.

Personal Information

Are you 21 yrs or older? Required by DHS Rule 2960 for CRF
Have you applied here before?

Desired Employment

Shift Desired
Please Check Referral

Present/Last Employment

Are you employed now?
If no, state last employment.
May we contact your present/last employer?




Give the names of three persons who are not related to you, that you have known for at least five years, and that we may call as a reference.

Service Record

Have you been free of chemical use problems for at least two years?
Are you legally eligible to work in the U.S.?

If you are hired to work at this facility, you will be required to furnish documentation within three working days showing you are a legal resident and are legally entitled to work in the U.S.


I understand that the facts contained in this employment application are true and complete to the best of my knowledge and, if employed, I understand that falsified statements on this application may be grounds for dismissal.

I authorize inquiries of all statements contained herein and the reference and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

I have also reviewed the attached privacy notice regarding the need for a background study by the State of Minnesota to determine my eligibility for employment at a licensed Children Residential Facility.

Consent to MN Department Of Human Services Background Study

As an applicant for employment with MLRC and if hired, as an employee of MLRC, I understand my eligibility for employment is greatly determined by my current and continued ability to successful pass a lawfully mandated MN DHS Background Study. I understand these background studies are necessary to ensure MLRC’s clientele are in contact with only those individuals who have been determined, by MN DHS, to not pose a safety risk to youths and/or adults under the care of MLRC.

Therefore, I have reviewed the attached MN DHS Background Study Privacy Notice. I now, and during my future tenure of employment with MLRC, fully consent MLRC to use the following information I have provided to validate my ability (as determined by MN DHS) to be in contact with MLRC’s clients. I further understand that now, or at any time in the future, my employment with MLRC may be immediately terminated, for cause, if I fail to successfully pass a MN DHS Background Study.

Have you lived in prior states within the U.S. other than Minnesota in the past 5 years?
Other names I have been known as, such as maiden or previously married name:

Please review application