Application for Employment

Equal access to programs, services and employment is available to all persons.  Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.

Position(s) applied for

Date of application

/

 /

Referral Source Advertisement Employee Relative Govt. Employment Agency
Walk-in Private Employment Agency

Other

Name

Last

First

Middle
Address

Street

 Social Security #
 

City

State

Zip Code
Telephone # Mobile/Beeper
Email      
If necessary; best time to call you at home is............................................................
May we contact you at work? ....................................................................................

Yes  No
If yes, work number and best time to call..........................................
If you are under 18 and it is required, can you furnish a work permit?............................

Yes  No
Have you submitted an application before?.................................................................

Yes  No
Are you legally eligible for employment in this country?...............................................

Yes  No
Date available for work...................

What is your desired salary range?...

$
Type of employment desired Full-Time Part-Time Temporary Seasonal
Will you travel if job requires it?.................................................................................

Yes  No
Are you able to meet the attendance requirements of the position?...............................

Yes  No
Will you work overtime if required?.............................................................................

Yes  No
If no, please explain
Have you ever pled "guilty" or "no contest" to, or been convicted of a crime?.................

Yes  No
If yes, please provide date(s) and details

Answering "yes" to these questions does not constitute an automatic bar to employment.  Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.
Driver's license number if driving is an essential job function

State
Employment History
Starting with your most recent employer, assignments or volunteer activities, provide the following information.
Employer Telephone #

Dates Employed

    

/

to

 /
Street Address City State Compensation (Starting)
Starting Job Title/Final Job Title $ per
Immediate Supervisor and Title

Hourly Salary

 

Commission

  
Reason for Leaving

Compensation (Final)
May we contact for reference? Yes No Later   $ per
Summarize the type of work performed and job responsibilities.

Hourly Salary

Commission

 
Employer Telephone #

Dates Employed

    

/

to

 /
Street Address City State Compensation (Starting)
Starting Job Title/Final Job Title $ per
Immediate Supervisor and Title

Hourly Salary

 

Commission

  
Reason for Leaving

Compensation (Final)
May we contact for reference? Yes No Later   $ per
Summarize the type of work performed and job responsibilities.

Hourly Salary

Commission

 
Employer Telephone #

Dates Employed

    

/

to

 /
Street Address City State Compensation (Starting)
Starting Job Title/Final Job Title $ per
Immediate Supervisor and Title

Hourly Salary

 

Commission

  
Reason for Leaving

Compensation (Final)
May we contact for reference? Yes No Later   $ per
Summarize the type of work performed and job responsibilities.

Hourly Salary

Commission

 
Employer Telephone #

Dates Employed

    

/

to

 /
Street Address City State Compensation (Starting)
Starting Job Title/Final Job Title $ per
Immediate Supervisor and Title

Hourly Salary

 

Commission

  
Reason for Leaving

Compensation (Final)
May we contact for reference? Yes No Later   $ per
Summarize the type of work performed and job responsibilities.

Hourly Salary

Commission

 
Skills & Qualifications
Word Excel MS Office PowerPoint Internet
Summarize any special training, skills, licenses and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.
Educational Background (if job related)
Starting with your most recent school attended, provide the following information.
School (include city & State Number of Years Completed Achieved
School
 (include city & State		 Number of Years Completed Achieved GPA
Class Rank		 Major Minor

GED

Diploma

Degree

GED

Diploma

Degree

GED

Diploma

Degree
References
List name and telephone number of three business/work references who are not related to you.
Name Title Relationship to Candidate Telephone Years Known

Additional Information
List professional, trade, business or civic associations and any offices held.
Exclude memberships that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any other similarly protected status.
Organization Offices Held
List special accomplishments, publications, awards, etc.
Exclude memberships that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any other similarly protected status.
List any additional information you would like us to consider.
Applicant Statement


I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law.  This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the mayor.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer's service, whenever it is discovered.
 


By submitting this online application, I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

The application will be emailed to City Hall once you click submit.