By initialing this document, you are swearing to the truth of the information provided.______
APPLICATION OF EMPLOYMENT
APPLICANT INFORMATION
Last Name First Name Middle D.O.B
Address Apartment Number
City State Zip Code
Social Security Number Driver’s License State
Phone Number Email
Available Start Date
Applying For: Desired Salary:
Position
Are you a citizen of the United States? If no, are you authorized to work in the U.S.?
Yes No Yes No
Have you worked for the City of Rollingwood in the past?
Yes No
How did you hear about us? _______________________________
Have you ever been convicted of a felony?
Yes No
If yes, when? Explain:
By initialing this document, you are swearing to the truth of the information provided.______
EDUCATION
What is your highest level of education?
High School College Graduate Degree
List the institution(s) and date(s) of enrollment Address of Institution
Did you graduate?
Yes No
Degree(s)
Major(s)
Minor(s)
PREVIOUS EMPLOYMENT
Company
Address Phone Number
Job Title Supervisor(s) Name
Start Date End Date May we contact them?
Responsibilities
By initialing this document, you are swearing to the truth of the information provided.______
Reason for Leaving
PREVIOUS EMPLOYMENT
Company
Address Phone Number
Job Title Supervisor(s) Name
Start Date End Date May we contact them?
Responsibilities
Reason for Leaving
PREVIOUS EMPLOYMENT
Company
Address Phone Number
Job Title Supervisor(s) Name
By initialing this document, you are swearing to the truth of the information provided.______
Start Date End Date May we contact them?
Responsibilities
Reason for Leaving
MILITARY SERVICE
Branch
Rank at Discharge
Dates of Service
Start Date End Date
Type of Discharge
If other than honorable, please explain:
THE CITY OF ROLLINGWOOD IS AN EQUAL OPPORTUNITY EMPLOYER, AND ABIDES BY FAIR
LABOR STANDARDS AND PRACTICES.