Fillable Application for Employment Advertisement Employee Relative Government Employment (City of Rogers)

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Application for Employment Advertisement Employee Relative Government Employment (City of Rogers)

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The Application for Employment Advertisement Employee Relative Government Employment (City of Rogers) form is 4 pages long and contains:

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File type: PDF

U.S.A. forms for City of Rogers

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Application for Employment
Please Print
Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation
to the applicant and/or interview process should notify a representative of the Human Resources Department.
Position(s) applied for ________________________________________________ Date of application ______________
POSITION MUST BE SPECIFIED
Referral Source:
□ Advertisement □ Employee □ Relative □ Government Employment
□ Walk-in □ Private Employment Agency □ Other ______________________
T
ype of employment desired:
□ Full-time □ Part-time □ Temporary □ Seasonal
N
ame ______________________________ __________________________ _____________________________
Last First Middle
A
ddress ______________________ __________________ ____ _________ Social Security # _________________
Street City State Zip
(Law Enforcement only)
Telephone # _________________ Alternate Phone # __________________ E-mail ______________________________
Date available for work ______________ What is your desired salary range? _________________________
May we contact you at work? □ Yes □ No
If yes, work number and best time to call? ______________________________
If necessary; best time to call you at home is? ______________________________
If you are under 18 and it is required can you furnish a work permit? □ Yes □ No
Have you submitted an application before? □ Yes □ No
Are you legally eligible for employment in this country? □ Yes □ No
Will you travel if the job required it? □ Yes □ No
Are you able to meet the attendance requirements of the position? □ Yes □ No
Will you work overtime if required? □ Yes □ No
Have you ever been convicted of a crime? □ Yes □ No
If so, please provide dates and details.___________________________________________________________
Answering “yes” to these questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature
of the violation, rehabilitation and position applied for will be taken into account.
Driver’s license number if driving is an essential job function. _________________________State __________
AN EQUAL OPPORTUNITY EMPLOYER
Human Resources www.rogersar.gov
301 W. Chestnut – Rogers, AR 72756 • (479) 621-1117 – (479) 631- 2767 fax
The Employment History section of this application must be
completed. Incomplete applications will not be considered.
Position applied for must be specified.
CLEAR FORM
EMPLOYMENT HISTORY
Starting with you most recent employer, assignments or volunteer activities, provide the following information.
Employer Telephone # From: Month Year To: Month Year
Date Employed
Street Address City State
Compensation (Starting)
Starting Job Title/Final Job Title $ per
_______________________________________________________________________________________________________________________________________
Immediate Supervisor and Title
_______________________________________________________________________________________________________________________________________
Reason for Leaving
Compensation (Final)
May we contact for reference? Yes No $ per
_______________________________________________________________________________________________________________________________________
Summary of job responsibilities:
_______________________________________________________________________________________________________________________________________
Employer Telephone # From: Month Year To: Month Year
Date Employed
Street Address City State
Compensation (Starting)
Starting Job Title/Final Job Title $ per
_______________________________________________________________________________________________________________________________________
Immediate Supervisor and Title
_______________________________________________________________________________________________________________________________________
Reason for Leaving
Compensation (Final)
May we contact for reference? Yes No $ per
_______________________________________________________________________________________________________________________________________
Summary of job responsibilities
_______________________________________________________________________________________________________________________________________
Employer Telephone # From: Month Year To: Month Year
Date Employed
Street Address City State
Compensation (Starting)
Starting Job Title/Final Job Title $ per
_______________________________________________________________________________________________________________________________________
Immediate Supervisor and Title
_______________________________________________________________________________________________________________________________________
Reason for Leaving
Compensation (Final)
May we contact for reference? Yes No $ per
_______________________________________________________________________________________________________________________________________
Summary of job responsibilities
_______________________________________________________________________________________________________________________________________
Employer Telephone # From: Month Year To: Month Year
Date Employed
Street Address City State
Compensation (Starting)
Starting Job Title/Final Job Title $ per
_______________________________________________________________________________________________________________________________________
Immediate Supervisor and Title
_______________________________________________________________________________________________________________________________________
Reason for Leaving
Compensation (Final)
May we contact for reference? Yes No $ per
_______________________________________________________________________________________________________________________________________
Summary of job responsibilities
_______________________________________________________________________________________________________________________________________
SKILLS & QUALIFICATIONS
□ Word □ Excel □ Access □ PowerPoint □ Internet
Summarize any special training, skills, licenses and/or certificates that may qualify you as being able to perform job-related functions
in the position for which you are applying:
____________________________________________________________________________________________________________
AN EQUAL OPPORTUNITY EMPLOYER
Educational Background (if job related)
Starting with you most recent school attended, provide the following information.
School (Include City & State)
Number of Years
Completed
Achieved
Major
Minor
GED
Diploma
Degree
GED
Diploma
Degree
GED
Diploma
Degree
References
List name and telephone number of three business/work references. Please do not list family members.
Name
Title
Relationship to
Candidate
Telephone
Years Known
Additional Information
List professional, trade, business or civic associations and any offices held.
Exclude memberships that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any
other similarly protected status.
Organization
Offices Held
List special accomplishments, publications, awards, etc.
Exclude memberships that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any
similarly protected status.
__________________________________________________________________________________________________
List any additional information you would like us to consider:
__________________________________________________________________________________________________
List names and relationship of any relatives currently employed by the City of Rogers:
__________________________________________________________________________________________________
AN EQUAL OPPORTUNITY EMPLOYER
APPLICANT STATEMENT
I certify that all information I have provided in order to apply for and secure work with the employer is true, complete,
and correct.
I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain
information from all references (personal and professional), employers, public agencies, licensing authorities and
educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume
or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees
or representatives, for seeking, gathering and using such information in the employment process and all other persons,
corporations or organizations for furnishing such information about me.
I understand that the employer does not unlawfully discriminate in employment and no question on this application is
used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by
applicable local, state, or federal law.
I understand that this application remains current for only 60 days. At the conclusion of that time, if I have not heard from
the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.
If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the
employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice,
except as may be required by law. This application does not constitute an agreement or contract for employment for any
specified period or definite duration.
I understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United
States and that federal immigration laws require me to complete an I-9 Form in this regard.
I understand that any information provided by me that is found to be false, incomplete or misrepresented in any
respect, will be sufficient cause to (1) cancel further consideration of this application, or (2) immediately discharge
me from the employer’s service, whenever it is discovered.
NOTICE: All applications and resume submissions are subject to public disclosure upon request under the
Arkansas Freedom of Information Act.
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
Signature of Applicant ___________________________________________________ Date _____________________
AN EQUAL OPPORTUNITY EMPLOYER
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Application for Employment Advertisement Employee Relative Government Employment (City of Rogers)

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Completed 14 July 2020

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