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An incomplete application may affect your consideration for employment. If necessary, attach a separate sheet for additional information.
The City of Russellville is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis of race, color, religion, creed, national origin or ancestry, sex, age, physical or mental disability, veteran status, genetic information or any other legally recognized protected basis under federal, state or local laws, regulations or ordinances.
Applicants with disabilities may be entitled to reasonable accommodation under the terms of the Americans with Disabilities Act and ensure an equal employment opportunity without imposing undue hardship on the City of Russellville. Please inform
the Human Resources Coordinator at 479-968-2098 if you need assistance completing any forms or to otherwise participate in the application
The primary reason for this question is to address any child labor laws.
List all employment experience for the past 7 years, starting with the most recent or present employer. Using a separate section for each position, describe in detail all work experience including periods of unemployment. You may include as part of your employment history any verified work performed on a volunteer basis. Resumes may not be substituted in lieu of completing the employment information.
Month/Year to Month/Year
Please comment on how your prior education and experiences qualify you for the type of employment you are seeking. Detail any past responsibilities and achievements. Note any special coursework, honors, activities, special projects, or any other data that will assist us in considering your application for employment.
I, the applicant, in connection with my application for employment at the City of Russellville hereby authorize the employer and any agent it authorizes to perform a pre-employment background screening check (including future screening for retention, promotion, or reassignment if applicable unless revoked in writing.)
I understand and agree to the following:
I understand that the employer may obtain a report, which consists of information having a bearing on job performance, and may include information from public and private sources, public records, courts, schools, former employers, and references on my driving record, court records, worker's compensation record, education, credentials, identity, and previous employment.
I understand and release people, companies, references, current and former employers, schools, municipal, county, state and federal agencies and courts, to provide all information that is requested to the employer or its authorized agents. I further release and hold harmless all of the above, including the employer, to the full extent permitted by law, from any liability or claims arising from retrieving and reporting of information concerning me. I agree that a copy or fax of this document shall be as valid as the original. I certify that the following facts and the information in my resume and/or application are true and correct.
Please exclude convictions that have been sealed or legally eradicated and misdemeanor conviction for which probation was completed and the cases were dismissed).
An affirmative answer to any of the above will not necessarily disqualify you from employment.
This field is not part of the form submission.
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