APPLICATION FOR EMPLOYMENT
Position(s) Applied For: _____________________________________ Date of Application: _____________________
How Did You Learn About Us?
Advertisement Relative Friend Online Job Board
Message Board Inquiry Radio Other _________________________
Last Name: ________________________________ First Name: _______________________________ MI: __________
Address: ________________________________ City: _____________________ State: ________ Zip: ______________
Cell Phone: ______________________ Home Phone: ______________________ Email: __________________________
Social Security Number (voluntary): _____________________________
If you are under 18 years of age, can you provide required proof Yes No
of your eligibility to work?
Have you ever filed an application with us before? Yes No
If yes, give date ________________________________
Have you ever been employed with us before? Yes No
If yes, give date ________________________________
Do any of your friends or relatives, other than spouse, work here? Yes No
Are you currently employed? Yes No
May we contact your present employer? Yes No
Are you prevented from lawfully becoming employed in this country Yes No
because of Visa or Immigration Status? Proof of citizenship or immigration
status will be required upon employment.
We consider applications for all positions without regard to race, color, religion, creed, gender, national
origin, age, disability, sexual orientation, citizenship status, genetic information or any other legally
protected status. The City of Altoona is an Equal Opportunity Employer.
Are you currently on “lay-off” status and subject to recall? Yes No
Date available for work _____/_____/_____ What is your desired salary range? ______________________
Are you available to work:
Full-Time (please indicate: 1 2 3 shift)
Part-Time (please indicate: Mornings Afternoons Evenings)
Temporary (please indicate: dates available _____/_____/_____ - _____/_____/_____)
EDUCATION
Name and Address of
School
Course of Study
Number of Years
Completed
Diploma
Degree
Elementary School
High School
Undergraduate College
Graduate Professional
Other (Specify)
Describe any specialized training, apprenticeship, skills and extra-curricular activities.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Describe any job-related training received in the United States military.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
List professional, trade, business or civic activities and offices held.
You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected
status.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
EMPLOYMENT EXPERIENCE
1
Employer Name:
Dates Employed
From
To
Address:
Telephone Number:
Job Title:
Hourly Rate/Salary
Starting
Final
Supervisor:
Reason for Leaving:
2
Employer Name:
Dates Employed
From
To
Address:
Telephone Number:
Job Title:
Hourly Rate/Salary
Starting
Final
Supervisor:
Reason for Leaving:
3
Employer Name:
Dates Employed
From
To
Address:
Telephone Number:
Job Title:
Hourly Rate/Salary
Starting
Final
Supervisor:
Reason for Leaving:
4
Employer Name:
Dates Employed
From
To
Address:
Telephone Number:
Job Title:
Hourly Rate/Salary
Starting
Final
Supervisor:
Reason for Leaving:
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may
exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.
ADDITIONAL INFORMATION
Summarize special job-related skills and qualifications acquired from employment or other experience.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Specialized Skills (Check All That Apply):
Commercial Driver’s License Forklift Computer/Internet Snow plow
Inspection/Emission License Data Entry Fax/Scanner Other: _____________________
State any additional information you feel may be helpful to us in considering your application.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
PROFESSIONAL REFERENCES
Name
Telephone
Relationship
1.
2.
3.
APPLICANT’S STATEMENT
I certify that answers given herein are true and complete. I authorize investigation of all statements contained in this
application for employment as may be necessary in arriving at an employment decision.
Note to applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE
REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
Can you perform the essential functions of the job, for which you are applying, either with or without a reasonable
accommodation?
Yes
No
This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant
wishing to be considered for employment beyond this time period should inquire as to whether or not applications are
being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship
with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer
may discharge Employee at any time with or without cause.
In the event of employment, I understand that false or misleading information given in my application or interview(s)
may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
___________________________________________________________ ____________________________
Signature of Applicant Date