Fillable 504 River Dr. * North Sioux City, SD (N. Sioux City City Hall)

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504 River Dr. * North Sioux City, SD (N. Sioux City City Hall)

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  • 7 check-boxes
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An Equal Opportunity Employer Page 1
Date: ___
_____________________ Position applied
for:__________________________________________________________
Directions: Please answer each question fully and accurately. No action will be taken on this application until you have answered
all questions and signed the back of the application in ink. Resumes and cover letters are not substitutes for the information
requested on this application.
APPLICANT INFORMATION
Name ___________________________________________________________________________________________________________________
Last First Middle
Address__________________________________________________________________________________________________________________
Street City State Zip
Telephone (______) ________________ Date available for work: _________________ Email Address: ___________________________________
List alias(es), nickname(s), or any other names you may have worked under: ___________________________________________________________
_________________________________________________________________________________________________________________________
Yes No
Yes No If yes, dates: ___________ to _____________
Yes No If yes, name and relationship?
___________________________________________
Yes No If yes, date and position?
___________________________________________
Yes No
Yes No If yes, phone number: (_____) ______ - __________
Yes No State: ________ #: ___________________________
Yes No
Yes No
Are you legally eligible for employment in the United States?
(Proof of US
Citizenship or immigration status required)
Have you ever been employed by the City of North Sioux City?
Are you related to any city employee or elected official?
Have you ever applied here before?
Do you have a High School Diploma or G.E.D. equivalent? May
we contact you at work?
Do you currently possess a valid driver’s license?
Are you willing to work overtime if required?
Are you willing to work alternating shifts if required?
Have you ever been fired from a job or asked to resign?
Yes No
If yes, please explain:______________________________________________________________________________________________________
________________________________________________________________________________________________________________________
Have you ever been convicted of a felony or misdemeanor? Yes No
If yes, please explain:______________________________________________________________________________________________________
________________________________________________________________________________________________________________________
(Factors such as date, nature, number of offenses, age at the time of offense, and rehabilitation will be considered)
Application for Employment
504 River Dr. * North Sioux City, SD 57049
Ph: (605) 232-4276
* Fax: (605) 232-0506
Web: www.northsiouxcity-sd.gov
An Equal Opportunity Employer Page 2
SKILLS & QUALIFICATIONS
Typing: ________ wpm
Do you possess a current Commercial Driver’s License (CDL)? Yes No
List any certifications:______________________________________________________________________________________________________
________________________________________________________________________________________________________________________
Describe your proficiency with computer hardware and software (list software):________________________________________________________
_
__________
______________________________________________________________________________________________________________
EDUCATION
(List schools attended, including high school, starting with the most recent)
School Years Completed Degree or Diploma Major
1)________________________________________________________________________________
______________________________________
2)_____________________________________________________________________________________________
_________________________
3)______________________________________________________________________________________________________________________
EMPLOYMENT HISTORY
(List present or most recent employers first, including military service assignments. If necessary, please attach an additional sheet to
explain gaps in employment)
1. Current Employer Supervisor
Address
Date (Month/Year) From To Salary/Wage______________
Position
Reason for leaving
May we contact this employer? Yes No Phone No.____________________
2. Name of Employer Supervisor
Address Phone______________________
Date (Month/Year) From To Salary/Wage______________
Position
Reason for leaving
3. Name of Employer Supervisor
Address Phone______________________
Date (Month/Year) From To Salary/Wage______________
Position
Reason for leaving
4. Name of Employer Supervisor
Address Phone______________________
Date (Month/Year) From To Salary/Wage______________
Position
Reason for leaving
5. Name of Employer Supervisor
Address Phone______________________
Date (Month/Year) From To Salary/Wage______________
Position
Reason for leaving
An Equal Opportunity Employer Page 3
PERSONAL STATEMENT (Attach additional sheets if necessary)
Please summarize you
r interest in working for the City of North Sioux City. Additionally, tell us about your special skills, abilities,
accomplishments, or military service that you feel most qualify you for the position for which you are applying:
_______________________________________________________________________________________________________________________
_
______________________________________________________________________________________________________________________
__
______________________________________________________________________________________________________________________
__
______________________________________________________________________________________________________________________
__
______________________________________________________________________________________________________________________
__
______________________________________________________________________________________________________________________
__
REFERENCES (Please provide three school, work, or personal references not related to you)
Name Title Phone Years Known
1)______________________________________________________________________________________________________________________
2)______________________________________________________________________________________________________________________
3)______________________________________________________________________________________________________________________
APPLICANT STATEMENT
PLEASE READ AND SIGN BELOW
I hereby certify that the information given by me is true and complete to the best of my knowledge and belief. I further authorize investigation of all
statements I have made. Misrepresentations, falsification, or omission of facts called for in this application or in the interview process is cause for
cancellation of this application or termination of employment.
I authorize the City of North Sioux City, its officers, agents and employees to conduct a background investigation (including criminal) prior to
making a decision regarding employment. I release and hold harmless the City of North Sioux City, its officers, agents, and employees, and the
person providing the information from any liability related to the performance or result of this check.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, initial and ongoing employment with the City of North
Sioux City is of an “at will” nature, which means that the employee may resign at any time and the employer may discharge an employee at any
time with or without cause. It is further understood that this relationship may not be changed by any written document or by conduct
unless an authorized executive of this organization specifically acknowledges such change in writing.
I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current
or past employer, an organizations to provide relevant information that may be useful in making a hiring decision. I release such persons and
organizations from any legal liability in making such statements.
I understand that if I am extended a conditional offer of employment, it may be conditioned upon my successfully passing a complete pre-
employment physical examination. I give my consent to any pre-employment or post-employment health screenings, physical limitations
testing, examinations, and/or any other requirements of the City of North Sioux City if a conditional offer of employment has been given. I
consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am
applying. We advise you not to resign or change your current employment status until you are advised that you have successfully completed the
health assessment. I understand that I may be required to successfully pass an alcohol and drug screening examination. I hereby consent to a
pre and/or post-employment alcohol/drug screen as a condition of employment, if required.
Finally, I understand that this application does not constitute a contract or guarantee of employment, or if employed, does not bind either party to a
specific period of employment.
Authorization for Reference Requests
I have applied with the City of North Sioux City for employment and I desire that they be fully advised of my record with former employers and
schools I have attended. I, therefore, give my permission and request that former employers and prior schools attended furnish any and
all requested information and records to the City of North Sioux City on their request for references in regard to the position for which I have
applied. In addition, I hereby release all involved parties from any and all liability of damages for requesting or providing the reference information.
SIGNATURE_________________________________________________ DATE______________________________________
The City of North Sioux City considers applicants for all positions without regard to race, color, religion, sex, age, national origin, marital or veteran status,
disability, creed, ancestry, political affiliation, or any other legally protected status. The City of North Sioux City is prepared to make reasonable
accommodations for applicants with a disability. If called for an interview, please advise the person calling of any accommodations that you may need.
PROFESSIONAL REFERENCES (Attach add
itional sheets if necessary)
SUBMIT APPLICATION
click to sign
signature
click to edit
An Equal Opportunity Employer Page 4
Applicant Survey (Voluntary)
H
ow did you learn about this position?
Job Service Center
Other City Department
Present City Employee
City of Vermillion Website
Other Website
Newspaper (specify____________________)
Other (specify )
W
ere you treated courteously when requesting job
information about city government? Yes No
Was the city job information readily available upon request? Yes No
Was the City job information easily understood? Yes No
I
f you answered “no” to any of the above, please explain:______________________________________________________________
____
________________________________________________________________________________________________________
____
________________________________________________________________________________________________________
____
________________________________________________________________________________________________________
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504 River Dr. * North Sioux City, SD (N. Sioux City City Hall)

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Completed 19 January 2021

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