EMPLOYMENT APPLICATION FORM
PLEASE PRINT ALL INFORMATION EXCEPT
SIGNATURE |
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DATE: _______________
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Name
____________________________________________________________________________________
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Last
First
Middle
Maiden |
Present address
_____________________________________________________________________
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Number
Street
City
State Zip |
How long have you lived at this
address? ______ |
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Telephone
( )
Social Security Number:
__________________ |
If under 18, please list age:
______ |
Position applied for
(1)______________________
and salary desired (2)
______________________
(Be specific) |
Days and Hours available to work
No Preference Thur ____________
Mon _______ Fri
____________
Tue ________ Sat
____________
Wed _______ Sun
____________ |
Employment desired:
qFULL-TIME
ONLY
qPART-TIME
ONLY
qFULL- OR PART-TIME |
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TYPE OF SCHOOL |
NAME OF SCHOOL |
LOCATION
(Complete mailing address) |
NUMBER OF YEARS COMPLETED |
MAJOR & DEGREE |
High School
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College
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Bus. or Trade School |
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Professional School
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HAVE YOU EVER BEEN CONVICTED OF A
CRIME, PLEAD GUILTY TO A CRIME OR RECEIVED A DEFERRED
ADJUDICATION FOR A CRIME?
q
No
q
Yes |
If yes, explain number crime(s),
nature of offense(s), how recently such offense(s) was/were
committed, sentence(s) imposed, and type(s) of rehabilitation.
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DO YOU HAVE A DRIVER'S LICENSE?
q
Yes
q
No |
What is your means of transportation
to work? |
Driver's license number:
__________________________ Expiration Date: ___________
State of issue _______
q Operator
q Commercial (CDL)
qChauffeur |
Have you had any accidents during
the past three years? |
How many? |
Have you had any moving violations
during the past three years? |
How Many? |
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Please list two references other
than relatives or previous employers. |
Name: |
Name: |
Position: |
Position: |
Company: |
Company: |
Address: |
Address: |
Relationship:
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Relationship:
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Telephone
( )
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Telephone
( )
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An application form sometimes makes
it difficult for an individual to adequately summarize a
complete background. Use the space below to summarize any
additional information necessary to describe your full
qualifications for the specific position for which you are
applying. |
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MILITARY |
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HAVE YOU EVER BEEN IN THE ARMED
FORCES? q
Yes q
No |
ARE YOU NOW A MEMBER OF THE NATIONAL
GUARD?
q
Yes q
No |
Specialty
Date
Entered Discharge Date
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Work Experience |
Please list your work experience
for the past five years beginning with your most recent job
held.
If you were self-employed, give firm name.
Attach additional
sheets if necessary. |
Name of employer
Address |
Name of last supervisor |
Employment dates |
Pay or salary |
City, State, Zip Code
Phone number |
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From
To |
Start
Final |
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Your last job title |
Reason for leaving (be specific) |
List the jobs you held, duties
performed, skills used or learned, advancements or promotions
while you worked at this company. |
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Name of employer
Address |
Name of last supervisor |
Employment dates |
Pay or salary |
City, State, Zip Code
Phone number |
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From
To |
Start
Final |
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Your Last Job Title |
Reason for leaving (be specific) |
List the jobs you held, duties
performed, skills used or learned, advancements or promotions
while you worked at this company. |
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Name of employer
Address |
Name of last supervisor |
Employment dates |
Pay or salary |
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City, State, Zip Code
Phone number |
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From
To |
Start
Final |
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Your last job title |
Reason for leaving (be specific) |
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List the jobs you held, duties
performed, skills used or learned, advancements or promotions
while you worked at this company. |
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Name of employer
Address |
Name of last supervisor |
Employment dates |
Pay or salary |
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City, State, Zip Code
Phone number |
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From
To |
Start
Final |
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Your last job title |
Reason for leaving (be specific) |
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List the jobs you held, duties
performed, skills used or learned, advancements or promotions
while you worked at this company. |
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May we contact your present
employer?
q
Yes q
No |
Did you complete this application
yourself
q
Yes q
No |
If not, who did?
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PLEASE READ CAREFULLY: APPLICATION
FORM WAIVER |
In exchange for the consideration of
my job application by the City of Shoreacres ("the City"), I
agree that: Employment with the City is under an
employment-at-will relationship. Neither the acceptance of this
application nor the subsequent entry into any type of employment
relationship, either in the position applied for or any other
position, and regardless of the contents of employee handbooks,
personnel manuals, benefit plans, policy statements, and the
like as they may exist from time to time, or other City
practices, shall serve to create an actual or implied contract
of employment, or to confer any right to remain an employee of
City, or otherwise to change in any respect the
employment-at-will relationship, and that the employment-at-will
relationship cannot be altered except by a written instrument
signed by the Mayor of the City. Both I and the City may end
the employment relationship at any time, without specified
notice or reason. If employed, I understand that the City may
unilaterally change or revise their benefits, policies and
procedures and such changes may include reduction in benefits. |
I authorize investigation of all
statements contained in this application. I have provided
truthful and complete information in response to the questions
in this application, and I understand that the misrepresentation
or omission of facts called for is good cause for dismissal at
any time without any previous notice. I hereby give the City
permission to contact schools, previous employers (unless
otherwise indicated), references, and others, and hereby release
the City and my schools, previous employers, references, and
others from any liability as a result of such contact. |
I also understand that (1) the City
has a drug and alcohol policy that provides for preemployment
testing as well as testing after employment; (2) consent to and
compliance with such policy is a condition of my employment; and
(3) continued employment is based on the successful passing of
testing under such policy. I further understand that continued
employment may be based on the successful passing of job-related
physical examinations. |
I understand that, in connection with
the routine processing of my employment application, the City
may request from a consumer reporting agency an investigative
consumer report including information as to my credit records,
character, general reputation, personal characteristics, and
mode of living. Upon written request from me, the City will
provide me with additional information concerning the nature and
scope of any such report requested by it, as required by the
Fair Credit Reporting Act. |
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Signature of applicant:
__________________________________________
Date: ___________________
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This City is an equal employment opportunity employer. We
adhere to a policy of making employment decisions without regard
to race, color, religion, sex, sexual orientation, national
origin, citizenship, age or disability. We assure you that your
opportunity for employment with this City depends solely on your
qualifications.
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Thank you for completing this application form and for your
interest in our business.
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PLEASE PRINT AND RETURN BY FAX TO
281.471.8955
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