Fillable CITY OF CREVE COEUR APPLICATION FOR EMPLOYMENT 300 (City of Creve Coeur)

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CITY OF CREVE COEUR APPLICATION FOR EMPLOYMENT 300 (City of Creve Coeur)

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08/24/2015
CITY OF CREVE COEUR
APPLICATION FOR EMPLOYMENT
300 N. NEW BALLAS ROAD CREVE
COEUR, MO 63141
(314) 872-2511 - PHONE
(314) 872-2539 - FAX
PLEASE PRINT CLEARLY DATE:______________________________
NAME _____________________________ADDRESS______________________________________________
CITY/STATE/ZIP____________________________________________________________________________
TELEPHONE___________________CELL PHONE:__________________BUS PHONE:________________
EMAIL ADDRESS:__________________________________________________________________________
POSITION APPLYING FOR:_________________________FULL-TIME, PART-TIME OR SEASONAL
(Circle your choice)
PREVIOUS MILITARY SERVICE:
ARE YOU A VETERAN?____ IF YES, BRANCH OF SERVICE_________________________________
DATES OF SERVICE: ENTERED:______________________ DISCHARGED:________________________
THIS SECTION TO BE COMPLETED ONLY BY APPLICANTS FOR POSITIONS WHICH REQUIRE
DRIVING ON THE JOB. A DRIVING RECORD CHECK WILL BE PERFORMED AS A CONDITION OF
ANY JOB OFFER TO SUCH APPLICANTS.
License no._____________________ Class of license____________________________
State of Issue: __________________ Restrictions _______________________________
Has your license ever been suspended or revoked? Yes____ No_____ If yes, on a separate sheet list the
details for each occurrence including: the offense, date, charge, place, court and action taken.
EDUCATIONAL BACKGROUND: INCLUDE ALL FORMAL TRAINING PROGRAMS AND
ACADEMIC DEGREES. ATTACH ADDITIONAL SHEET IF NECESSARY.
NAME OF SCHOOL
OR PROGRAM
LOCATION
CREDITS
COMPLETED
DEGREE
EARNED
COMPLETE/
GRADUATE?
08/24/2015
WORK EXPERIENCE: BEGINNING WITH YOUR MOST RECENT EMPLOYMENT, LIST A COMPLETE
STATEMENT OF YOUR WORK HISTORY.
ATTACH ADDITIONAL SHEETS IF NECESSARY
1. POSITION HELD_________________________________ SALARY____________________________
DATES OF EMPLOYMENT from:_________________________ to:_________________________________
EMPLOYER___________________________________________________________________________________
ADDRESS_____________________________________________________________________________________
Street city state zip
SUPERVISOR’S NAME __________________________________TELEPHONE__________________________
DUTIES/RESPONSIBILITIES ___________________________________________________________________
REASON FOR LEAVING _______________________________________________________________________
2. POSITION HELD_________________________________ SALARY____________________________
DATES OF EMPLOYMENT from:_________________________ to:_________________________________
EMPLOYER___________________________________________________________________________________
ADDRESS_____________________________________________________________________________________
Street city state zip
SUPERVISOR’S NAME __________________________________TELEPHONE__________________________
DUTIES/RESPONSIBILITIES ___________________________________________________________________
REASON FOR LEAVING _______________________________________________________________________
3. POSITION HELD_________________________________ SALARY____________________________
DATES OF EMPLOYMENT from:_________________________ to:_________________________________
EMPLOYER___________________________________________________________________________________
ADDRESS_____________________________________________________________________________________
Street city state zip
SUPERVISOR’S NAME __________________________________TELEPHONE__________________________
08/24/2015
DUTIES/RESPONSIBILITIES ___________________________________________________________________
REASON FOR LEAVING _______________________________________________________________________
List any additional training, special qualifications, skills or honors you would like considered:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
REFERENCES: List the following information for at least three references who may be contacted concerning
your work history and background. DO NOT INCLUDE RELATIVES
1. NAME _____________________________________________________________________________________
ADDRESS ________________________________________EMAIL ADDRESS_________________________
TELEPHONE __________________________CELL___________________BUSINESS__________________
HOW DO YOU KNOW THIS PERSON:________________________________________________________
HOW LONG?______________
2. NAME _____________________________________________________________________________________
ADDRESS ________________________________________EMAIL ADDRESS_________________________
TELEPHONE __________________________CELL___________________BUSINESS__________________
HOW DO YOU KNOW THIS PERSON:________________________________________________________
HOW LONG?______________
3. NAME _____________________________________________________________________________________
ADDRESS ________________________________________EMAIL ADDRESS_________________________
TELEPHONE __________________________CELL___________________BUSINESS__________________
HOW DO YOU KNOW THIS PERSON:________________________________________________________
HOW LONG?______________
Do you have any commitments which may restrict your ability to perform your job duties? ____yes ____no
If yes, provide details: ____________________________________________________________________________
______________________________________________________________________________________________
Do you have any objection to the City of Creve Coeur making inquiries of your past or present employer(s) regarding
your work history? _______yes _______no If yes, provide details:______________________________________
08/24/2015
_______________________________________________________________________________________________
Have you ever been discharged or forced to resign from a position? _____yes _____no If yes, provide details
including the name of the employer and the reason for the action taken:
________________________________________________________________________________________________
________________________________________________________________________________________________
__________________________________________________________________________________________________
Have you ever been employed by/taken an examination for the City of Creve Coeur? _____yes _____no
Do you have any relatives now employed by the City of Creve Coeur? _____yes _____no If yes, list names and his/her
relationship to you:__________________________________________________________________________________
__________________________________________________________________________________________________
If you are selected for a position, how soon are you available to start work?
_______________________________________________
PLEASE READ CAREFULLY BEFORE SIGNING
City policy requires an applicant, when a bona fide job offer has been made, to pass a physical examination (at
the City’s expense) and be certified by the City’s physician as fit to perform the duties of the position. The pre-
employment examination for all candidates includes a drug screen. Failure of the applicant to consent to these
inquiries and tests, and depending on the position, a credit check and background check, and skill and other
applicable tests, will disqualify the applicant from present and future employment consideration by the City.
Federal law requires that the City hire only United States citizens and lawfully authorized alien workers. If you
are selected for a position with the City of Creve Coeur, you will be required to comply with the requirements
of the Immigration and Naturalization Act of 1986. This law requires you to present documentation of your
identity and eligibility to work in the US and to complete a federal I-9 form. This form must be completed on
the first day of employment for all employees.
It is the policy of the City of Creve Coeur not to discriminate on the basis of race, color, religion, national
origin, ancestry, sex, gender, gender identity, sexual orientation, age, disability or familial status, or other status
protected by law except where specific age or physical requirements constitute a bona fide occupational
qualification. The job duties will be reviewed with you to determine your ability to perform the essential
functions of the position.
CERTIFICATION OF THE APPLICANT – SEE ALSO SEPARATE SHEET ATTACHED. READ
CAREFULLY BEFORE SIGNING.
I certify that all the answers and statements herein contained are true to the best of my knowledge and belief. I
understand that any misstatement of material facts, or omission of any material facts, will subject me to possible
disqualification or dismissal.
SIGNATURE OF APPLICANT:____________________________________Date:_____________________
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08/24/2015
CITY OF CREVE COEUR
300 N. NEW BALLAS ROAD
CREVE COEUR, MO 63141
CERTIFICATE OF APPLICANT
AUTHORIZATION FOR RELEASE OF INFORMATION
(Read carefully before signing)
I, ____________________________________, hereby certify that all statements made on or in
connection with my application for employment are true and complete to the best of my knowledge and
belief, and I understand and agree that any misstatements or omission of material facts can cause
forfeiture on my part of all rights to employment by the City of Creve Coeur.
I also do hereby authorize all law enforcement agencies, the Veterans Administration, U. S. Army, U. S.
Navy, U. S. Air Force, all military agencies, all federal, state or local government agencies, state and
federal tax bureaus, credit bureaus, schools, universities, and current and prior employers, to furnish
representatives of the City with any and all available information regarding me in order that they may
determine my suitability for employment with the City of Creve Coeur.
I authorize my present and past employers to discuss my character, integrity and reputation with
representatives of the City.
I authorize the release of any and all information regarding my employment, credit, or any other
information, whether personal or otherwise, by the persons and entities described herein that may or
may not be on their records and release such persons and entities from all liability for any damage
whatsoever that may issue from furnishing such information to representatives of the City of Creve
Coeur.
A photo copy of this authorization will be considered as effective and valid as the original.
__________________________________ ___________________________________
Signature of Applicant Date
__________________________________ ___________________________________
Month and Day of Birth Last Four Digits of Social Security Number
__________________________________ ___________________________________
Driver’s License Number State of Issuance
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08/24/2015
CITY OF CREVE COEUR
FAIR CREDIT REPORTING ACT DISCLOSURE AND AUTHORIZATION
In considering you as an applicant for employment or evaluating me as a current employee, we may choose to
secure and use information contained in either a consumer report or investigative consumer report about you
obtained from a consumer reporting agency when: (1) considering your application for employment (2) making
a decision whether to offer you employment, (3) deciding whether to continue your employment or (4) making
other employment-related decisions directly affecting you.
For explanation purposes:
A "consumer reporting agency" is a person or business that, on a cooperative nonprofit basis, or for
monetary fees or dues, regularly assembles or evaluates consumer credit information or other information
on consumers for a person who has a legitimate business need for the information or intends to use the
information for employment purposes.
A "consumer report" means any written, oral or other communication of any information by a consumer
reporting agency bearing on your credit worthiness, credit standing, credit capacity, character, general
reputation, personal characteristics, or mode of living which is used or expected to be used or collected in
whole or in part for the purpose of serving as a factor in establishing your eligibility for employment
purposes.
An "investigative consumer report" means a consumer report or portion thereof in which information on
your character, general reputation, personal characteristics, or mode of living is obtained through personal
interviews with your neighbors, friends, or associates reported on or with others with whom you are
acquainted or who may have knowledge concerning any such items of information.
Please refer to the attached written summary of your rights under the Fair Credit Reporting Act for further
information.
AUTHORIZATION
By signing below, you hereby authorize us to obtain a consumer report and/or an investigative report about you
for the purposes stated above. If hired, this authorization shall remain on file and shall serve as an ongoing
authorization for us to procure such reports at any time during the employment period.
_______________________________________________________ ____________________________
(Signature) (Date)
_______________________________________________________
(Printed)
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CITY OF CREVE COEUR APPLICATION FOR EMPLOYMENT 300 (City of Creve Coeur)

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Completed 22 January 2021

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