EMPLOYMENT APPLICATION FORM

 

PLEASE PRINT ALL INFORMATION EXCEPT SIGNATURE

 

 

DATE: _______________    

Name ____________________________________________________________________________________          

                  Last                                 First                                Middle                           Maiden

Present address _____________________________________________________________________     

                                 Number           Street                                  City                     State                Zip

How long have you lived at this address? ______  

 

 

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

 

TYPE OF SCHOOL

NAME OF SCHOOL

LOCATION
(Complete mailing address)

NUMBER OF YEARS COMPLETED

MAJOR & DEGREE

High School

 

 

 

 

 

 

 

 

 

 

College

 

 

 

 

 

 

 

 

 

 

Bus. or Trade School

 

 

 

 

 

 

 

 

 

Professional School

 

 

 

 

 

 

 

 

 

 

 

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.

 

 

 

 

 

 

                   

 

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?   

 

Please list two references other than relatives or previous employers.

Name:            

Name:            

Position:         

Position:         

Company:      

Company:      

Address:        

Address:        

Relationship:             

Relationship:             

Telephone  (        )                                                

Telephone  (        )                                                       

 

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.

 

 

 

 

 

 

 

     

 

 

 MILITARY

 

 

 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                    

 

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

 

From

To

Start

Final

 

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.

 

 

 

 

 

Name of employer
Address

Name of last supervisor

Employment dates

Pay or salary

City, State, Zip Code
Phone number

 

From

To

Start

Final

 

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.

 

 

 

 

             

 

Name of employer
Address

Name of last supervisor

Employment dates

Pay or salary

 

City, State, Zip Code
Phone number

 

From

To

Start

Final

 

 

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.

 

 

 

 

 

 

Name of employer
Address

Name of last supervisor

Employment dates

Pay or salary

 

City, State, Zip Code
Phone number

 

From

To

Start

Final

 

 

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.

 

 

 

 

May we contact your present employer?     q Yes q No

Did you complete this application yourself   q Yes q No

If not, who did?          

 

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.

 

 

Signature of applicant: __________________________________________

 

Date: ___________________

 

 

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.

 

Thank you for completing this application form and for your interest in our business.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 PLEASE PRINT AND RETURN BY FAX TO 281.471.8955

 

 

 

Copyright 2005-2013 City of Shoreacres