Full Time Employment Application

It is the policy of the City to provide equal opportunity with regard to all terms and conditions of employment. The City complies with federal and state laws prohibiting discrimination on the basis of race, color, religion, creed, national origin, gender, disability, veteran status, age or any other protected characteristic.

Name:

Phone:

Address:

City/State/Zip:

Position Applied For:

Shift Preferred:
--Select One-- 1 2 3 4 Any
Special training or skills (languages, machine operation, etc.) that would benefit you in the job for which you are applying:

Expected Pay:

Would you accept full-time work?:
--Select One-- Yes No
Would you accept part-time work?:
--Select One-- Yes No
On what date would you be available for work?:
dd/mm/yyyy
Have you ever been employed here before?:  --Select One-- Yes No   Dates: From mm/dd/yyyy - To mm/dd/yyyy
Do you have a legal right to be employed in the U.S.?
--Select One-- Yes (proof required if hired) No
If you are under 18, can you provide a work permit if required?:
--Select One-- Yes No
Are you able to perform the essential functions of the job for which you are applying (with or without reasonable accommodation)?
This question os not designed to elicit information about the applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.
--Select One-- Yes No Need more information about the job's 'essential functions' to respond
Explain any gaps in your employment, other than those due to personal illness, injury or disability:

Have you ever been fired or asked to resign for a job?
--Select One-- Yes No
If Yes, please explain:


Educational Background

Grammar School
Name and Location:

Course of Study:

Did you graduate?:
--Select One-- Yes No
Degree or Diploma:


High School
Name and Location:

Course of Study:

Did you graduate?:
--Select One-- Yes No
Degree or Diploma:


College
Name and Location:

Course of Study:

Did you graduate?:
--Select One-- Yes No
Degree or Diploma:


Graduate School
Name and Location:

Course of Study:

Did you graduate?:
--Select One-- Yes No
Degree or Diploma:


Vocational or other training
Name and Location:

Course of Study:

Did you graduate?:
--Select One-- Yes No
Degree or Diploma:


Continuing Education:

Previous Employers and Addresses
Check the box by the employer(s) you do not wish us to contact. List the most recent first.

 Company Name:

Contact name:

Address:

Dates of employment:
From: mm/dd/yyyy - To: mm/dd/yyyy
Position:

Reason for leaving:


 Company Name:

Contact name:

Address:

Dates of employment:
From: mm/dd/yyyy - To: mm/dd/yyyy
Position:

Reason for leaving:


 Company Name:

Contact name:

Address:

Dates of employment:
From: mm/dd/yyyy - To: mm/dd/yyyy
Position:

Reason for leaving:


 Company Name:

Contact name:

Address:

Dates of employment:
From: mm/dd/yyyy - To: mm/dd/yyyy
Position:

Reason for leaving:

 I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected, and if I am employed, my employment may be terminated at any time.

 In consideration of my employment, I agree to conform to the City’s rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the City's option.

 I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the City.

 I understand that no City representative, other than its Manager, and then only when in writing and signed by the City Manager, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.

Applicant’s Signature:

Date:

dd/mm/yyyy